Department of Surgical Oncology, Institut Curie, St Cloud, France.
Department of Gynecology, Poissy-St Germain hospital, Poissy, France.
PLoS One. 2019 Jul 10;14(7):e0210917. doi: 10.1371/journal.pone.0210917. eCollection 2019.
The organization of health care for breast cancer (BC) constitutes a public health challenge to ensure quality of care, while also controlling expenditure. Few studies have assessed the global care pathway of early BC patients, including a description of direct medical costs and their determinants. The aims of this multicenter prospective study were to describe care pathways of BC patients in a geographic territory and to calculate the global direct costs of early stage BC during the first year following diagnosis.
OPTISOINS01 was a multicenter, prospective, observational study including early BC patients from diagnosis to one-year follow-up. Direct medical costs (in-hospital and out-of-hospital costs, supportive care costs) and direct non-medical costs (transportation and sick leave costs) were calculated by using a cost-of-illness analysis based on a bottom-up approach. Resources consumed were recorded in situ for each patient, using a prospective direct observation method.
Data from 604 patients were analyzed. Median direct medical costs of 1 year of management after diagnosis in operable BC patients were €12,250. Factors independently associated with higher direct medical costs were: diagnosis on the basis of clinical signs, invasive cancer, lymph node involvement and conventional hospitalization for surgery. Median sick leave costs were €8,841 per patient and per year. Chemotherapy was an independent determinant of sick leave costs (€3,687/patient/year without chemotherapy versus €10,706 with chemotherapy). Forty percent (n = 242) of patients declared additional personal expenditure of €614/patient/year. No drivers of these costs were identified.
Initial stage of disease and the treatments administered were the main drivers of direct medical costs. Direct non-medical costs essentially consisted of sick leave costs, accounting for one-half of direct medical costs for working patients. Out-of-pocket expenditure had a limited impact on the household.
乳腺癌（BC）的医疗保健组织是一个公共卫生挑战，需要确保医疗质量，同时控制支出。很少有研究评估早期 BC 患者的全球护理途径，包括直接医疗成本及其决定因素的描述。这项多中心前瞻性研究的目的是描述 BC 患者在地理区域的护理途径，并计算诊断后第一年早期 BC 的全球直接成本。
OPTISOINS01 是一项多中心、前瞻性、观察性研究，包括从诊断到一年随访的早期 BC 患者。直接医疗成本（住院和院外成本、支持性护理成本）和直接非医疗成本（交通和病假成本）是通过基于自下而上的成本效益分析计算的。使用前瞻性直接观察方法为每位患者就地记录消耗的资源。
分析了 604 名患者的数据。可手术 BC 患者诊断后 1 年管理的直接医疗成本中位数为 12250 欧元。与更高的直接医疗成本独立相关的因素是：基于临床体征的诊断、浸润性癌症、淋巴结受累和常规手术住院。每位患者每年的平均病假成本为 8841 欧元。化疗是病假成本的独立决定因素（无化疗的患者为 3687 欧元/人/年，化疗的患者为 10706 欧元/人/年）。40%（n=242）的患者报告了每年 614 欧元/人的额外个人支出。这些成本的驱动因素尚未确定。
疾病的初始阶段和所使用的治疗方法是直接医疗成本的主要驱动因素。直接非医疗成本主要由病假成本组成，占工作患者直接医疗成本的一半。自付支出对家庭的影响有限。
