title: Cost of breast cancer based on real-world data: a cancer registry study in Italy.
abstract: In European countries, it is difficult for local health organizations to determine the resources allocated to different hospitals for breast cancer. The aim of the current study was to examine the costs of breast cancer during the different phases of the diagnostictherapeutic sequence based on real world data.
  
  
  
  To identify breast cancer cases diagnosed between 2007 and 2011, we used the cancer registry of the Agency for Health Protection of the Province of Milan (3.2 million inhabitants). A generalized linear model controlling for patient age, cancer stage and Charlson co-morbidity index was used to calculate the adjusted mean costs for each hospital and for each study phase. Regression analyses were based on dependent variables of individual costs (diagnosis, treatment, follow-up and total cost were logtransformed. The following independent variables were included as covariates: age at diagnosis, hospital volume, stage, job category, educational level, marital status, comorbidities, deprivation index. Total and mean costs were computed for several variables and for each phase. On average for each subject, the costs were collected over 2.5 years.
  
  
  
  A total of 12,580 breast cancer cases were studied. The mean cost of diagnosis was €414, the mean cost of treatment was €8,780, the mean overall cost of follow-up was approximately €2,351, and the mean total direct medical cost was €10,970. The age of the patients, stage of tumor and employment level of the patient were significantly correlated with the variability of the costs. The highest variability in costs was observed for the follow-up costs, in which 38% of hospitals fell outside the 95% confidence interval. In the overspending-hospitals, patients received an intensive follow-up regimen with scintigraphy and thoracic CAT (computerized axial tomography).
  
  
  
  In this study, which represents the first population-level study of its kind in Italy, we estimated all direct medical costs for the 6-month period before the diagnosis of breast cancer and the first two years after diagnosis. Patients were identified from the local cancer registry. The analysis offers insight into the utilization of resources incurred by one major area of interest of cancer care in Italy.
authors.affiliation: School of Economics and Business, Cattaneo-LIUC University, Corso Matteotti 22, 21053, Castellanza, VA, Italy. scapri@liuc.it.
authors.forename: Stefano
authors.identifier: 0000-0003-4633-4420
authors.initials: S
authors.lastname: Capri
authors.affiliation: Epidemiology Unit, Agency for Health Protection of the Province of Milan, C.so Italia 19, 20122, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Russo
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000191:economics*; D015897:Comorbidity; D003365:Costs and Cost Analysis; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006295:Health Resources / Q000191:economics; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D007558:Italy; D016014:Linear Models; D008875:Middle Aged; D009367:Neoplasm Staging; D012042:Registries
keywords: Breast cancer; Costs; Health care utilization; Italy; Real world data