The economic burden of cancer survivorship in the UK: a patient-level analysis

Purpose: To describe the economic burden of cancer survivorship for disease-free breast, colorectal and prostate cancer patients in the UK, one year post-diagnosis. Methods: Patient-level data were collected over a three months period 12-15 months post diagnosis to estimate the monthly societal costs incurred by disease-free cancer survivors. Self-reported resource utilisation data were obtained via the electronic Patient-reported Outcomes from Cancer Survivors (ePOCS) system and included community-based health and social care, medications, travel costs and carers’ time. Hospital costs were retrieved through data linkage with the patient-level information and costing systems (PLICS). Patients also provided information on their pre-diagnostic and current employment status. Multivariate regression analysis was used to examine cost predictors. Results: Overall 296 patients were included in the analysis, including 135 breast cancer, 83 colorectal cancer and 78 prostate cancer patients. The average monthly societal cost was £260 (95% CI: £198-£322) and was incurred by 92% of patients. These were divided into costs to the NHS (mean: £177, 95% CI: £131-£224), patients’ out-of-pocket (OOP) costs (mean: £25, 95% CI: £9-£42) and costs of informal care (mean: £70, 95% CI: £38-£102).The distribution of societal costs was skewed with a small number of patients incurring very high monthly costs. Of 144 patients working pre-diagnosis, 110 (76.4%) were still working 15 months post-diagnosis. Multivariate analyses showed higher NHS costs for breast cancer patients. Significant predictors of OOP costs included age and socioeconomic status. Conclusions: In the UK, the population of cancer survivors is increasing and the full economic consequences of the disease are still poorly understood. This study found that the economic burden of cancer survivorship is unevenly distributed in the population and that disease-free cancer survivors still required substantial support from family and friends over 1 year post-diagnosis. In addition, this study illustrates the feasibility of using an innovative online data collection platform to routinely collect patient-reported resource utilisation information.