Francisci S, Busco S, Capodaglio G, Gigli A, Guzzinati S, Lopez T, Mallone S, Pierannunzio D, Tavilla A, Zorzi M

GRELL Ascension Meeting, Lisbon, 29-31 May 2019




The number of women with a breast cancer diagnosis is growing and sustainability of health expenditure is becoming an important issue. Aim of this work is to provide indicators for the estimation of health care expenditure directly correlated to diagnosis, care and monitoring of breast cancer patients.



Retrospective study based on 49,000 prevalent female cases with breast cancer diagnosis in 8 cancer registry areas covering North, Centre and South Italy. Cases are linked at individual level to administrative data on hospital care, outpatient care and drug usage, in order to estimate the health expenditure directly attributable to diagnosis and treatment of patients along a three-phase care pathway: initial (diagnostic procedures and treatments in the 12 months after diagnosis), continuing (follow-up treatments and monitoring for relapses), final (end-of-care treatments in the 12 months prior to death).



Cost profiles are very high during the first 3 months of the initial phase, reach a plateau in the continuing phase and rise up again during the last 3 months prior to death. Hospitalization covers 55% of total expenditure, followed by outpatient services (29%) and drugs prescribed outside hospital (16%). There is a trend by stage and age at diagnosis: more advanced stages correspond to higher costs, especially among younger women. There is also variability in the ratio between hospital and ambulatory costs across CRs.



Estimation of cost distribution by type of service and by phase of care is a useful tool for health care planning, as it allows to evaluate the amount of expenditure as well as costs determinants. The Epicost study confirms the importance of primary prevention and early diagnosis in a public health perspective, finalized to reducing inequalities.


The Epicost project was financed by the Italian Health Minister (CCM).