title: Estimating the direct and indirect costs of lung cancer: a prospective analysis in a Greek University Pulmonary Department.
abstract: BACKGROUND
  Lung cancer (LC) is a disease with high morbidity and mortality while the prevention and treatment constitutes a significant financial burden. This economic burden has an increasing trend, with hospitalization being the highest cost factor in most studies, while the patients' quality of life (QoL) and response to treatment is not proven to be positively affected.
  
  
  OBJECTIVE
  To evaluate the direct and indirect cost of managing patients with LC in Greece according to stage and histological type of cancer, total chemotherapy cycles, age, gender, smoking habit, overall survival (OS), treatment outcome (TO) and QoL.
  
  
  METHODS
  One hundred thirteen of 128 consecutive patients met the inclusion criteria and were included in this prospective study. Patient enrolment started in August 2011 and ended in November 2011. The duration of the patient follow up was 32 months after diagnosis until end of registry. Total direct cost included diagnosis and treatment cost. Indirect cost constituted of patient's and family caregivers lost days of productivity. QoL was assessed with EORTC-QLQ-30 and Lung Cancer Symptom Scale (LCSS) questionnaires before treatment and every three months.
  
  
  RESULTS
  Total direct cost was €1,853,984 and chemotherapy drugs was the highest cost factor (€1,216,421). Total indirect cost was 28,774 days of which 27,293 were related to patients. Total direct cost was significantly related to the increased number of total chemotherapy cycles, longer OS, histological type of adenocarcinoma, female gender and younger patients. No relation was found between total indirect cost and the above factors. When the association between total direct/indirect cost and QoL was examined no significant results were drawn.
  
  
  CONCLUSIONS
  The burden of LC on health care systems remains very high and was associated with the increased number of total chemotherapy cycles, longer OS, adenocarcinoma histological type of cancer, female gender and younger patients. Chemotherapy drugs constituted the higher factor of total direct cost. Indirect cost was considerably higher for patients than family caregivers and did not significantly differ in relation to the above factors. No significant conclusion was drawn regarding QoL and total direct/indirect cost.
authors.affiliation: 1 Pulmonary Department, Aristotle University of Thessaloniki, "G. Papanikolaou" General Hospital, Thessaloniki, Greece ; 2 Laboratory of Hygiene, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Department of Food Technology, School of Food Technology and Nutrition, Alexander Technological Educational Institute, Thessaloniki, Greece.
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Zarogoulidou
authors.affiliation: 1 Pulmonary Department, Aristotle University of Thessaloniki, "G. Papanikolaou" General Hospital, Thessaloniki, Greece ; 2 Laboratory of Hygiene, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Department of Food Technology, School of Food Technology and Nutrition, Alexander Technological Educational Institute, Thessaloniki, Greece.
authors.forename: Efharis
authors.initials: E
authors.lastname: Panagopoulou
authors.affiliation: 1 Pulmonary Department, Aristotle University of Thessaloniki, "G. Papanikolaou" General Hospital, Thessaloniki, Greece ; 2 Laboratory of Hygiene, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Department of Food Technology, School of Food Technology and Nutrition, Alexander Technological Educational Institute, Thessaloniki, Greece.
authors.forename: Despina
authors.initials: D
authors.lastname: Papakosta
authors.affiliation: 1 Pulmonary Department, Aristotle University of Thessaloniki, "G. Papanikolaou" General Hospital, Thessaloniki, Greece ; 2 Laboratory of Hygiene, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Department of Food Technology, School of Food Technology and Nutrition, Alexander Technological Educational Institute, Thessaloniki, Greece.
authors.forename: Dimitris
authors.initials: D
authors.lastname: Petridis
authors.affiliation: 1 Pulmonary Department, Aristotle University of Thessaloniki, "G. Papanikolaou" General Hospital, Thessaloniki, Greece ; 2 Laboratory of Hygiene, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Department of Food Technology, School of Food Technology and Nutrition, Alexander Technological Educational Institute, Thessaloniki, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Porpodis
authors.affiliation: 1 Pulmonary Department, Aristotle University of Thessaloniki, "G. Papanikolaou" General Hospital, Thessaloniki, Greece ; 2 Laboratory of Hygiene, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Department of Food Technology, School of Food Technology and Nutrition, Alexander Technological Educational Institute, Thessaloniki, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Zarogoulidis
authors.affiliation: 1 Pulmonary Department, Aristotle University of Thessaloniki, "G. Papanikolaou" General Hospital, Thessaloniki, Greece ; 2 Laboratory of Hygiene, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Department of Food Technology, School of Food Technology and Nutrition, Alexander Technological Educational Institute, Thessaloniki, Greece.
authors.forename: Paul
authors.initials: P
authors.lastname: Zarogoulidis
authors.affiliation: 1 Pulmonary Department, Aristotle University of Thessaloniki, "G. Papanikolaou" General Hospital, Thessaloniki, Greece ; 2 Laboratory of Hygiene, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece ; 3 Department of Food Technology, School of Food Technology and Nutrition, Alexander Technological Educational Institute, Thessaloniki, Greece.
authors.forename: Malamatenia
authors.initials: M
authors.lastname: Arvanitidou
keywords: Lung cancer (LC); direct cost; indirect cost; quality of life (QoL)