The financial impact of a breast cancer detected within and outside of screening: lessons from the Australian Lifepool cohort
AuthorSaxby, K; Nickson, C; Mann, GB; Velentzis, L; Bromley, HL; Procopio, P; Canfell, K; Petrie, D
Source TitleAustralian and New Zealand Journal of Public Health
University of Melbourne Author/sProcopio, Pietro; Mann, Gregory; Nickson, Carolyn; Petrie, Dennis; Velentzis, Louiza Sofia; Bromley, Hannah
Melbourne School of Population and Global Health
Document TypeJournal Article
CitationsSaxby, K., Nickson, C., Mann, G. B., Velentzis, L., Bromley, H. L., Procopio, P., Canfell, K. & Petrie, D. (2020). The financial impact of a breast cancer detected within and outside of screening: lessons from the Australian Lifepool cohort. AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, 44 (3), pp.219-226. https://doi.org/10.1111/1753-6405.12976.
Access StatusOpen Access
OBJECTIVE: To determine the government and out-of-pocket community costs (out-of-hospital medical services and prescription medicines) associated with screen-detected and community-detected cancers (i.e. cancers detected outside of Australia's organised screening program [BreastScreen]). METHODS: We analyse administrative data on government-subsidised medical services and prescription medicines for 568 Victorian women diagnosed with breast cancer or ductal carcinoma in situ (DCIS). Using multivariable regression analysis, we estimate the government and out-of-pocket community costs incurred in the three years after diagnosis for screen-detected cancers and community-detected cancers. Additionally, we estimate the government costs associated with diagnosis within and outside of BreastScreen. RESULTS: Average government costs for breast cancer diagnosis were similar within and outside of BreastScreen [$808 (lower limit 676; upper limit 940) vs $837 (95%CI 671; 1,003) respectively]; however, women with community-detected cancers incurred an additional $254 (95%CI 175; 332) out-of-pocket. Controlling for differences in known cancer characteristics, compared to screen-detected cancers, community-detected breast cancers were associated with an additional $2,622 (95%CI 644; 4,776) in government expenditure in the three years following diagnosis. Adverse cancer characteristics that were more prevalent in community-detected cancers (high grade, lymph node involvement, HER2 positive receptor status) were associated with increased government and out-of-pocket costs. CONCLUSIONS: Community-detected breast cancers were associated with increased government and out-of-pocket costs. Implications for public health: These costs should be considered when evaluating current and alternative breast cancer screening strategies.
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