Economic burden associated with breast cancer recurrence: findings from a retrospective analysis of health system data.
BACKGROUND
The economics of breast cancer recurrence are poorly understood. For this retrospective cohort study, the authors evaluated the economic burden of breast cancer recurrence by using data from a large Midwestern healthcare system.


METHODS
Women with Stage I or II breast cancer (according to the American Joint Commission on Cancer staging criteria) were identified from the tumor registry of the Henry Ford Health System. The economic burden of breast cancer recurrence was estimated from patient charges (adjusted to 2003 U.S. dollars).


RESULTS
From 1996 to 2002, 1616 patients with early breast cancer were identified, including 192 patients who had recurrent tumors. Patients with recurrence had significantly greater charges in the 6-month and 12-month postrecurrence periods (45,855 U.S. dollars and 79,253 U.S. dollars, respectively) compared with the 6-month and 12-month prerecurrence periods (10,715 U.S. dollars and 12,344 U.S. dollars, respectively; both P <.001). This was evident for all recurrence types (locoregional, contralateral breast, and distant), but it was most evident for distant recurrences. In a regression analysis that was adjusted for baseline characteristics, the mean monthly charges were significantly greater for patients with recurrence versus patients without recurrence (P <.001), and this was true for each recurrence type. For women with recurrence (n = 74 patients), the mean charges during the 6-month postrecurrence period were significantly greater than mean charges during the initial 6-month period after diagnosis (50,355 U.S. dollars vs. 38,254 U.S. dollars; P <.01). Quarterly charges for continuing care postrecurrence were significantly greater than prerecurrence charges (4934 U.S. dollars vs. 1825 U.S. dollars; P <.001). The mean charges for terminal care were significantly greater (P <.01) for women with recurrence (n = 27 patients, 63,434 U.S. dollars) versus women without recurrence (n = 65 patients, 53,872 U.S. dollars).


CONCLUSIONS
Patients with early breast cancer who experienced recurrence required more costly care than patients who did not develop recurrent disease. Therapies that reduce the risk of recurrence may reduce costs significantly.
Department of Biostatistics and Research Epidemiology, Henry Ford Health System, Detroit, Michigan 48105, USA. llamera1@hfhs.org
Lois
L
Lamerato
Suzanne
S
Havstad
Sanjay
S
Gandhi
David
D
Jones
David
D
Nathanson
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000191:economics*; D012044:Regression Analysis; D012189:Retrospective Studies