Advanced breast cancer: an evaluation of the cost of recurrence

In the context of a medicoeconomic study of the adjuvant treatment of breas t cancer we evaluated the cost of the recurrence. This cost was assessed fr om the medical records of 146 patients having presented either distant meta stases, or a local recurrence followed or not by metastases between 1983 an d 1990. We checked according to published data that the frequency of the me tastatic risk is negligible if beyond 5 years after the local recurrence. C osts are expressed in 1995 French Francs (FF), with the French Social Secur ity point of view. From the medical record, we calculated the mean cost of each type of recurrence using medical costs (visits, drugs and treatments, assessments, tests, hospital care, outpatient services...) and non medical costs (patient transportation). The costs are 175,168 FF (standard deviatio n or SD: 127,972) for metastatic recurrence, and respectively 287,582 FF (S D: 142,280) and 115,705 FF (SD: 78,677)for local recurrence followed or not by metastases. There is a significant difference between these figures (p < 0.001). The hospitalization costs are around 66% of the total cost of eac h type of recurrences and they are significantly higher (p < 0.005) when me tastatic disease occurs after a local recurrence. The mean cost of isolated local recurrence added to metastatic recurrence, 290,873 FF, is not differ ent from that of local recurrence followed by metastases, 287,582 FF (p = 0 .15). These results will be integrated in a model in order to evaluate the long-term economic consequences of an adjuvant strategy in the treatment of breast cancer and presented in other publications.