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Global treatment costs of breast cancer by stage: A systematic review


  • Li Sun
  • Rosa Legood
  • Isabel dos-Santos-Silva
  • Shivani Mathur Gaiha
  • Zia Sadique


Background: Published evidence on treatment costs of breast cancer varies widely in methodology and a global systematic review is lacking. Objectives: This study aimed to conduct a systematic review to compare treatment costs of breast cancer by stage at diagnosis across countries at different levels of socio-economic development, and to identify key methodological differences in costing approaches. Data sources: MEDLINE, EMBASE, and NHS Economic Evaluation Database (NHS EED) before April 2018. Eligibility criteria: Studies were eligible if they reported treatment costs of breast cancer by stage at diagnosis using patient level data, in any language. Study appraisal and synthesis methods: Study characteristics and treatment costs by stage were summarised. Study quality was assessed using the Drummond Checklist, and detailed methodological differences were further compared. Results: Twenty studies were included, 15 from high-income countries and five from low- and middle-income countries. Eleven studies used the FIGO staging system, and the mean treatment costs of breast cancer at Stage II, III and IV were 32%, 95%, and 109% higher than Stage I. Five studies categorised stage as in situ, local, regional and distant. The mean treatment costs of regional and distant breast cancer were 41% and 165% higher than local breast cancer. Overall, the quality of studies ranged from 50% (lowest quality) to 84% (highest). Most studies used regression frameworks but the choice of regression model was rarely justified. Few studies described key methodological issues including skewness, zero values, censored data, missing data, and the inclusion of control groups to estimate disease-attributable costs. Conclusions: Treatment costs of breast cancer generally increased with the advancement of the disease stage at diagnosis. Methodological issues should be better handled and properly described in future costing studies.

Suggested Citation

  • Li Sun & Rosa Legood & Isabel dos-Santos-Silva & Shivani Mathur Gaiha & Zia Sadique, 2018. "Global treatment costs of breast cancer by stage: A systematic review," PLOS ONE, Public Library of Science, vol. 13(11), pages 1-14, November.
  • Handle: RePEc:plo:pone00:0207993
    DOI: 10.1371/journal.pone.0207993

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    Cited by:

    1. Iasmina Petrovici & Mihaela Ionica & Octavian C. Neagoe, 2021. "Economic Crisis: A Factor for the Delayed Diagnosis of Breast Cancer," IJERPH, MDPI, vol. 18(8), pages 1-10, April.
    2. Chunhuan Lao & Mohana Mondal & Marion Kuper-Hommel & Ian Campbell & Ross Lawrenson, 2022. "Differences in Breast Cancer Costs by Cancer Stage and Biomarker Subtype in New Zealand," PharmacoEconomics - Open, Springer, vol. 6(4), pages 539-548, July.
    3. Hofmarcher, Thomas & Lindgren, Peter & Wilking, Nils, 2022. "Cancer Care in Türkiye in a European Context," IHE Report / IHE Rapport 2022:10, IHE - The Swedish Institute for Health Economics.
    4. Alfredo Palacios & Carlos Rojas-Roque & Lucas González & Ariel Bardach & Agustín Ciapponi & Claudia Peckaitis & Andres Pichon-Riviere & Federico Augustovski, 2021. "Direct Medical Costs, Productivity Loss Costs and Out-Of-Pocket Expenditures in Women with Breast Cancer in Latin America and the Caribbean: A Systematic Review," PharmacoEconomics, Springer, vol. 39(5), pages 485-502, May.
    5. Ian Grady & Sean Grady & Nailya Chanisheva, 2021. "Long-term cost of breast cancer treatment to the United States Medicare Program by stage at diagnosis," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(9), pages 1365-1370, December.
    6. Francesco Saverio Mennini & Marco Trabucco Aurilio & Simone Gazzillo & Claudia Nardone & Paolo Sciattella & Andrea Marcellusi & Raffaele Migliorini & Valerio Sciannamea & Andrea Piccioni & Matteo Bolc, 2021. "An Analysis of the Social and Economic Costs of Breast Cancer in Italy," IJERPH, MDPI, vol. 18(17), pages 1-12, August.
    7. Michela Franchini & Stefania Pieroni & Edgardo Montrucchio & Jacopo Nori Cucchiari & Cosimo Di Maggio & Enrico Cassano & Brunella Di Nubila & Gian Marco Giuseppetti & Alberto Nicolucci & Gianfranco Sc, 2021. "The P.I.N.K. Study Approach for Supporting Personalized Risk Assessment and Early Diagnosis of Breast Cancer," IJERPH, MDPI, vol. 18(5), pages 1-15, March.

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