背景:乳腺癌是目前全球癌症发病率的主要原因。由于疾病的高负担,包括不利的流行病学和经济影响,乳腺癌对国际社会和经济产生了负面影响。我们的目的是系统地回顾美国乳腺癌的经济负担,加拿大,澳大利亚,和西欧(英国,法国,德国,西班牙,意大利,挪威,瑞典,丹麦,荷兰,和瑞士),目的是讨论我们结果的政策和实践含义。
方法:我们纳入了英语发表的研究,以成本为焦点,使用主要数据源来告知乳腺癌女性的资源使用情况。我们专注于自2017年以来发表的研究,但自2012年以来报告的成本。2023年1月25日进行的系统搜索确定了有关相关国家乳腺癌经济负担的研究。MEDLINE,Embase,通过Ovid搜索EconLit数据库。根据三个方面评估研究质量:(1)成本发现的有效性;(2)直接成本发现的完整性;(3)间接成本发现的完整性。我们根据国家/地区对成本进行分组,癌症阶段(早期相比转移性),和四个资源类别:医疗保健/医疗,药物,诊断,和间接成本。成本以美国(2022年美元)和国际(2022年国际美元)美元标准化到2022年。
结果:纳入了53项研究。美国(n=19)和加拿大(n=9)的研究占多数(53%),其次是西欧国家(42%)。医疗保健/医疗费用是大多数人(89%)的重点,其次是药物(25%),然后是诊断(17%)和间接成本(17%)。三十六(68%)包括早期癌症费用,17(32%)包括转移性癌症费用,23%的人报告在这些癌症阶段的成本。没有确定的研究明确比较了各国的成本。跨成本类别,美国的成本范围往往高于其他任何国家。转移性乳腺癌的成本高于早期癌症。当计入间接成本时,特别是在生产力损失方面,它们往往高于任何其他估计的直接成本(例如,诊断,药物,和其他医疗费用)。
结论:所确定的研究设计和估计成本在国家内部和国家之间都存在很大的异质性。尽管如此,目前的经验文献表明,与早期开始治疗相关的费用可以抵消潜在避免或减轻晚期和更严重的乳腺癌的总体经济负担.规模较大,国家,需要进行经济负担研究,定期更新,以确保对乳腺癌等疾病的经济负担有一个持续和不断变化的观点,为政策和实践提供信息。
BACKGROUND: Breast cancer is currently the leading cause of global cancer incidence. Breast cancer has negative consequences for society and economies internationally due to the high burden of disease which includes adverse epidemiological and economic implications. Our aim is to systematically review the estimated economic burden of breast cancer in the United States (US), Canada, Australia, and Western Europe (United Kingdom, France, Germany, Spain, Italy, Norway, Sweden, Denmark, Netherlands, and Switzerland), with an objective of discussing the policy and practice implications of our results.
METHODS: We included English-language published studies with cost as a focal point using a primary data source to inform resource usage of women with breast cancer. We focussed on studies published since 2017, but with reported costs since 2012. A systematic search conducted on 25 January 2023 identified studies relating to the economic burden of breast cancer in the countries of interest. MEDLINE, Embase, and EconLit databases were searched via Ovid. Study quality was assessed based on three aspects: (1) validity of cost findings; (2) completeness of direct cost findings; and (3) completeness of indirect cost findings. We grouped costs based on country, cancer stage (early compared to metastatic), and four resource categories: healthcare/medical, pharmaceutical drugs, diagnosis, and indirect costs. Costs were standardized to the year 2022 in US (US$2022) and International (Int$2022) dollars.
RESULTS: Fifty-three studies were included. Studies in the US (n = 19) and Canada (n = 9) were the majority (53%), followed by Western European countries (42%). Healthcare/medical costs were the focus for the majority (89%), followed by pharmaceutical drugs (25%), then diagnosis (17%) and indirect (17%) costs. Thirty-six (68%) included early-stage cancer costs, 17 (32%) included metastatic cancer costs, with 23% reporting costs across these cancer stages. No identified study explicitly compared costs across countries. Across cost categories, cost ranges tended to be higher in the US than any other country. Metastatic breast cancer was associated with higher costs than earlier-stage cancer. When indirect costs were accounted for, particularly in terms of productivity loss, they tended to be higher than any other estimated direct cost (e.g., diagnosis, drug, and other medical costs).
CONCLUSIONS: There was substantial heterogeneity both within and across countries for the identified studies\' designs and estimated costs. Despite this, current empirical literature suggests that costs associated with early initiation of treatment could be offset against potentially avoiding or reducing the overall economic burden of later-stage and more severe breast cancer. Larger scale, national, economic burden studies are needed, to be updated regularly to ensure there is an ongoing and evolving perspective of the economic burden of conditions such as breast cancer to inform policy and practice.