title: Health system costs for stage-specific breast cancer: a population-based approach.
abstract: OBJECTIVE
  The objective of the present analysis was to determine the publicly funded health care costs associated with the care of breast cancer (bca) patients by disease stage.
  
  
  METHODS
  Incident cases of female invasive bca (2005-2009) were extracted from the Ontario Cancer Registry and linked to administrative datasets from the publicly funded system. The type and use of health care services were stratified by disease stage over the first 2 years after diagnosis. Mean costs and costs by type of clinical resource used in the care of bca patients were compared with costs for a matched control group. The attributable cost for the 2-year time horizon was determined in 2008 Canadian dollars.
  
  
  RESULTS
  This cohort study involved 39,655 patients with bca and 190,520 control subjects. The average age in those groups was 61.1 and 60.9 years respectively. Most bca patients were classified as either stage i (34.4%) or stage ii (31.8%). Of the bca cohort, 8% died within the first 2 years after diagnosis. The overall mean cost per bca case from a public payer perspective in the first 2 years after diagnosis was $41,686. Over the 2-year time horizon, the mean cost increased by stage: i, $29,938; ii, $46,893; iii, $65,369; and iv, $66,627. The attributable cost of bca was $31,732. Cost drivers were cancer clinic visits, physician billings, and hospitalizations.
  
  
  CONCLUSIONS
  Costs of care increased by stage of bca. Cost drivers were cancer clinic visits, physician billings, and hospitalizations. These data will assist planning and decision-making for the use of limited health care resources.
authors.affiliation: Health Outcomes and PharmacoEconomics ( hope ) Research Centre, Sunnybrook Health Sciences Centre, Toronto, ON. ; Department of Pharmacology, University of Toronto, Toronto, ON. ; International Centre for Health Innovation, Richard Ivey School of Business, Western University, London, ON. ; Applied Research in Cancer Control, Cancer Care Ontario, Toronto, ON.
authors.forename: N
authors.initials: N
authors.lastname: Mittmann
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, ON.
authors.forename: J M
authors.initials: JM
authors.lastname: Porter
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, ON.
authors.forename: J
authors.initials: J
authors.lastname: Rangrej
authors.affiliation: Health Outcomes and PharmacoEconomics ( hope ) Research Centre, Sunnybrook Health Sciences Centre, Toronto, ON.
authors.forename: S J
authors.initials: SJ
authors.lastname: Seung
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, ON.
authors.forename: N
authors.initials: N
authors.lastname: Liu
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, ON.
authors.forename: R
authors.initials: R
authors.lastname: Saskin
authors.affiliation: Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON.
authors.forename: M C
authors.initials: MC
authors.lastname: Cheung
authors.affiliation: Princess Margaret Cancer Centre, University Health Network, Toronto, ON.
authors.forename: N B
authors.initials: NB
authors.lastname: Leighl
authors.affiliation: Applied Research in Cancer Control, Cancer Care Ontario, Toronto, ON. ; Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON.
authors.forename: J S
authors.initials: JS
authors.lastname: Hoch
authors.affiliation: Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON.
authors.forename: M
authors.initials: M
authors.lastname: Trudeau
authors.affiliation: McMaster University, Hamilton, ON.
authors.forename: W K
authors.initials: WK
authors.lastname: Evans
authors.affiliation: Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON.
authors.forename: K N
authors.initials: KN
authors.lastname: Dainty
authors.affiliation: Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON.
authors.forename: C
authors.initials: C
authors.lastname: DeAngelis
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, ON. ; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON.
authors.forename: C C
authors.initials: CC
authors.lastname: Earle
keywords: Breast cancer; costs; disease stage; population-based analysis