Costs of home care for advanced breast and cervical cancer in relation to cost-effectiveness of screening.

The costs of home care in the Netherlands are estimated for women with advanced breast and cervical cancer. We observe a growing role of intensive home care for the terminally ill patients. The average costs of home care are dfl 8,500 per patient for breast cancer patients and dfl 7,200 for cervical cancer patients. More than half of these costs are incurred in the last month before death. The level of home care in the preceding months is quite modest (dfl 120 per month for both diseases), not taking into account informal care. The costs of home care for patients with advanced cancer are only slightly related to the site of the primary tumor from which the metastases originate. Total average costs per patient during advanced disease, including hospital and nursing home care, amount to dfl 42,700 for breast cancer and dfl 29,000 for cervical cancer. This difference in costs is largely attributable to the longer duration of advanced disease for breast cancer, which substantially affects hospital costs. The high costs of care to patients with advanced cancer contribute to a favourable cost-effectiveness ratio of those screening programmes which reduce mortality and consequently the costs of care to advanced cancer patients.