[Macro-economic calculation of spending versus micro-economic follow-up of costs of breast cancer].
BACKGROUND
In the healthcare field, the ability to make economic forecasts requires knowledge of the costs of caring for major diseases. In the case of a semi-chronic condition like cancer, this cost covers all the episodes of care associated with a patient. An evaluation of a macro-economic method of calculating costs for treating non-metastatic cancer, covering all hospital episodes, is proposed. This method is based entirely on the use of annual hospital activity databases, linked to data concerning the incidence of cancer. It allows us to obtain the global cost of care for a neoplasm of a particular site, without the need to reconstruct the whole care pathway of the patients.


METHODS
The model was assessed by comparing it's own results, in the particular case of breast cancer to those issuing from a micro-economic follow-up of 115 patients. Data for macro-economic calculation are extracted from the national French hospital database for the year 1999 and from cancer incidence data. The prospective study was done in 1995, in a comprehensive cancer centre.


RESULTS
Macro-economic calculation leads to a cost of 14,555 Euro, for primary breast cancer. Prospective follow-up showed a cost of 14,350 Euro (data corrected, 1999 value). With a difference of 1%, there was a clear cohesion of the two results, while a higher level of divergence was noticed (from 1 to 15%) in the comparison between therapeutic techniques. Accuracy and reliability of results were evaluated.


CONCLUSIONS
This method may be extended to all types of neoplasms. This method cannot be used instead of follow-up studies, for cost-efficacy or cost-severity analysis, but may be interesting beyond economic forecasts, in the field of payment per pathology.
Borella
L
L
Fédération Nationale des Centres de Lutte Contre le Cancer, 101, rue de Tolbiac, 75013 Paris. borella@fnclcc.fr
Paraponaris
A
A
D001943:Breast Neoplasms / Q000191:economics* / Q000628:therapy; D002173:Cancer Care Facilities / Q000191:economics; D003365:Costs and Cost Analysis; D003953:Diagnosis-Related Groups; D005260:Female; D005602:France; D017048:Health Care Costs; D017721:Hospital Costs; D006801:Humans; D017059:Models, Econometric; D011446:Prospective Studies; D013997:Time Factors