The true cost of chemotherapy

A new study published today is the first to investigate the total non-healthcare cost of chemotherapy to the UK.

It includes the cost of lost productivity, work absence, and personal costs such as paying for transport and parking for treatment, the cost of wigs and new bras, and over the counter medications.

The UEA research team say that better targeting of treatment could help avoid placing unnecessary costs upon patients, their caregivers and wider society.

Prof Richard Fordham, from UEA's Norwich Medical School, said: "Breast cancer is the most common cancer in women and second most common cancer overall with two million cases per year worldwide.

"Most patients require surgery, additional radiotherapy, chemotherapy, hormone therapy or a combination of these to reduce the risk of the cancer coming back. Around a third of breast cancer patients receive chemotherapy, but there are grey areas around which patients do and don't need chemotherapy.

"As well as the cost of the treatment itself, there are many societal and personal costs associated with chemotherapy. These might include taking time off work, paying for hospital transport or parking, paying for over-the-counter medications or dietary supplements, the cost of wigs, headscarves and new bras, and the cost of informal care.

"But until now it has not been known what the total cost of all of this really is. We wanted to find out what the true total cost of chemotherapy is for patients, caregivers and wider society, for treating breast cancer in the UK."

The research team collected data from sources including UK cancer registries, clinical guidelines and published patient survey data. Patient and staff views were collected through semi-structured interviews.

Key findings:

• The total cost of breast cancer chemotherapy in the UK economy is over £248 million.
• Societal productivity losses of £141.4 million -- including £3.2 million lost to premature mortality, and £133.7 million lost to short-term (£28.7 m) and long-term (105m) work absence. Further costs include £3.4m associated with mortality losses from secondary malignancies due to adjuvant chemotherapy and £1.1m in lost productivity arises from informal care provision.
• £1.1 million in lost productivity arises from informal care provision.
• Out-of-pocket patient costs for chemotherapy total £4.2million, or an annual average of £1,100 per patient.

In addition, costs for the emotional wellbeing of carers could be as much as £82 million. Emotional wellbeing reflects how much additional income would be required to offset a wellbeing loss.

Dr Stephanie Howard-Wilsher, also of UEA's Norwich Medical School, said: "We spoke to breast cancer patients who had undertaken chemotherapy to better understand the actual experiences and impacts of these costs. We also interviewed healthcare staff involved in breast cancer care for their views on chemotherapy and associated costs.

"The interviews with patients really show the impact that breast cancer has on lives. They talk about their worlds just falling apart, and chemotherapy side effects like hair loss, tiredness, constipation and diarrhea, loss of taste. And they also talk about the emotional impact for their families and those caring for them.

Researcher Anna Sweeting, from UEA's Norwich Medical School, said: "Interviews with healthcare professionals showed us how patients cope with chemotherapy differently. For some patients, their cognitive function is never quite the same afterwards, they suffer with 'chemo brain'. And it also gave us insight into the impact for families, including children's mental health.

"Our work shows how chemotherapy carries significant and far-reaching indirect costs for society, as well as for patients and their carers -- beyond the costs associated with the treatment itself."

"The greatest burden accrued to society is in patient productivity losses. Patient out-of-pocket expenses and costs of informal care were smaller by comparison but nevertheless significant. Better targeting of chemotherapy treatment could help avoid placing unnecessary costs upon patients, their caregivers and wider society," added health economist and former UEA researcher Krishnali Parsekar.

'Societal costs of chemotherapy in the UK: an incidence-based cost-of-illness model for early breast cancer' is published in the journal BMJ Open on January 5, 2021.