Indirect Costs of Metastatic Breast Cancer Are Substantial

Caroline Helwick

October 2012, Vol 3, No 7 - Breast Cancer Symposium


San Francisco, CA—The indirect costs of metastatic breast cancer are substantial and are much higher than the costs of early breast cancer, according to what may be the first study to compare costs related to lost productivity in the population with breast cancer.

The study was reported at the 2012 Breast Cancer Symposium by Yin Wan, MS, of Pharmerit International, Bethesda, MD. The senior research-
er was Lee Schwartzberg, MD, Medi­­cal Director of the West Clinic in Memphis, TN.

“Breast cancer is mostly prevalent in women of working age, and the breast cancer–related indirect costs, such as productivity loss, cannot be overlooked,” noted Ms Wan.

The aim of the study was to estimate indirect costs (ie, sick leave and short-term disability) associated with metastatic breast cancer compared with early breast cancer and with the general population without cancer. The study included data from the MarketScan Health and Productivity Management database (2005-2009), which includes information about absenteeism, short-term disability insurance, and workers’ compensation program services.

The indirect costs associated with sick leave and short-term disability were estimated by multiplying leave days with daily wages (2011 Bureau of Labor Statistics). Propensity score matching was performed for patients with early breast cancer in relation to patients with metastases.

The analysis included a cohort composed of 139 patients with metastases, 432 patients with early breast cancer, and 820 controls eligible for sick leave; a second cohort of those who were eligible for short-term disability included 432 patients with metastases, 1552 patients with early breast cancer, and 4682 controls. The mean age was approximately 50 years for all groups.

In the short-term disability cohort, the patients with metastases had a higher mean comorbidity index than the patients with early breast cancer.After matching by age, payer type, region, index year, and comorbidities, patients with metastases had significantly more short-term disability days and related costs than patients with early-stage breast cancer—41 days versus 25 days, and $6166 versus $3690, respectively.

Patients with metastases had more sick leave days and related costs than the controls—16 days versus 9 days, and $2383 versus $1282, respectively. The patients with metastases also had significantly more short-term disability days and higher costs versus the controls—41 days versus 4 days, and $6166 versus $558, respectively.

Patients with metastases had higher total mean leave days and related costs (40 days and $5975) than patients with early breast cancer (23 days and $3452) or the controls (5 days and $711).

The multivariate analysis was ad­justed for age, region, health insurance, index diagnosis year, baseline chemotherapy, chemotherapy during follow-up, and Charlson comorbidity index. The analysis showed that pa­tients with metastases incurred 48% greater short-term disability costs than patients with early breast cancer. The patients with metastases also incurred 56% greater sick leave costs and nearly 12 times higher short-term disability costs than the controls.

Older patients, non-HMO payers, and patients not receiving chemotherapy during follow-up were associated with lower short-term disability costs.

The differences in indirect costs between patients with metastatic breast cancer and early breast cancer may be partly explained by how resource intensive, more toxic, and longer lasting the treatment for meta­static breast cancer is compared with treatment for early breast cancer, Ms Wan suggested.

The productivity losses of caregivers were not examined. The study relied on sick leave and short-term disability data as the only measures of productivity loss. Additional sources of productivity loss (ie, time spent seeking cancer treatment and care) were not assessed.