Societal costs of chemotherapy in the UK: an incidence-based cost-of-illness model for early breast cancer

AIM: To estimate annual societal costs associated with chemotherapy for early breast cancer in the UK. DESIGN: Mixed methods: (a) an incidence-based cost-of-illness model was developed of indirect costs in patients with breast cancer and carers, and estimated from diagnosis through active treatment until death; (b) interviews with stakeholders were also undertaken to understand actual experiences and impacts of these costs. DATA SOURCES: Model data were collated from relevant national data sources covering general population statistics, UK cancer registries, clinical guidelines and published literature, and patient survey data. Patient and staff views were collected through semistructured interviews. PARTICIPANTS: Model: patients with early breast cancer receiving systemic anticancer therapy in the UK. Interviews were undertaken with women who had chemotherapy and medical practitioners involved in breast cancer care. RESULTS: Total costs of chemotherapy in the UK economy are over £248 million. Societal productivity losses amount to £141.4 million, which includes £3.2 million associated with premature mortality, short-term and long-term work absence (£28.6 million and £105 million, respectively). £3.4 million is associated with mortality losses from secondary malignancies due to adjuvant chemotherapy. A further £1.1 million in lost productivity arises from informal care provision. Out-of-pocket costs per round of chemotherapy account for £4.2 million, or an annual average of almost £1100 per patient. Interview findings support the cost burden modelled and also highlight the impact on cognitive function of patients and how this could increase the cost burden to patients, their families and wider society. In addition, estimated costs for carer emotional well-being are £82 million in lost quality of life. CONCLUSION: Chemotherapy use carries significant indirect costs for society, as well as patients and their carers. These wider costs and societal perspective should be considered by commissioners to ensure chemotherapy is better targeted at those who most need it and to avoid placing unnecessary costs on patients, their caregivers and wider society.