title: How to make the best use of limited resources in breast cancer treatment--experiences in Bosnia & Herzegovina.
abstract: Availability of effective treatment has been shown to have a profound, positive impact on survival of breast cancer patients. However, with passing of time treatment of breast cancer has become more complex and associated with increase of costs that puts an enormous burden on health care resources. In order to compare the costs and outcomes of different treatments, we have made our own assessment of costs of breast cancer treatment based on the existing situation in Bosnia & Herzegovina (B&H) and data available from the relevant literature. In B&H costs of breast cancer therapy constitute about one third of the total cost for all tumor types therapies, and this is proportional to the relative number of the treated patients. Prices of overall treatment vary predominantly according to the use of specific adjuvant chemotherapy (CT) and hormonal therapy (HT). FAC (5 fluorouracil/doxorubicin/cyclophosphamide/methotrexate/5 fluorouracil), higher doses of epirubicin in FE(100)C are twice as high compared with FAC. Inclusion of taxanes further increases costs (40-fold for AC[(doxorubicin/cyclophosphamide) + paclitaxel x 4]; 60-fold for TAC with docetaxel; 70-fold for dense-dose regimens in relation to FEC). Treatment with aromatase inhibitors is 11-13 times more expensive compared to tamoxifen. Therapy of metastatic disease is heterogeneous, and it is likely to prolong median survival by 14 months on average. Overall costs vary according to specific treatment modalities used. From CMF and FEC to trastuzumab and docexatel prices have increased 300 times. All health care systems have a limited budget, but wise use of health care resources is of special importance in countries in transition with evident weakness in economy. In the early breast cancer (EBC) setting, therapy should be individualised according to evidence-based data and respecting available resources. In metastatic disease (MBC) it should be based on risk factors, predictive factors, toxicity, preference of the patient herself and available resources, and weighted against effect on quality of life and treatment costs.
authors.affiliation: Institute of Oncology of Clinical Centre, University of Sarajevo, Sarajevo, Bosnia & Herzegovina. nerminaobralic@gmx.net
authors.forename: N
authors.initials: N
authors.lastname: Obralić
authors.forename: S
authors.initials: S
authors.lastname: Beslija
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D017522:Bosnia and Herzegovina; D001943:Breast Neoplasms / Q000191:economics / Q000628:therapy*; D017281:Cost of Illness; D005260:Female; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006801:Humans; D008507:Medically Underserved Area
chemical_list: D000970:Antineoplastic Agents