Economic Burdens of Breast Cancer in Taiwan

Breast cancer is the first leading incident female cancer in Taiwan. In 2006, 6,895 women were newly diagnosed with invasive breast cancer and 660 for carcinoma in situ of breast in Taiwan. The age‐standardized incidence rates per 100,000 persons were 49.99 for invasive breast cancer and 4.75 for carcinoma in situ of breast(Bureau of Health Promotion, 2006). The incidence of breast cancer has been arising by an annual rate of 7.3% in the past 5 years (Department of Health, 2006). Despite recent advances in oncology, breast cancer remains the fourth highest cause of deaths due to any type of cancer among females in Taiwan. Breast cancer accounted for 1,439 deaths in 2006, showing the age‐standardized mortality rate of 10.41 per 100,000 persons (Bureau of Health Promotion, 2006). Economic burdens associated with breast cancer can be substantial. Direct medical costs, such as physician fees, chemotherapy, radiotherapy, prescription and/or over‐the‐counter drugs; resources used by patient and family, such as transportation costs of seeking treatment, copayment for National Health Insurance (NHI)‐reimbursed care, and other out‐of‐pocket payment; as well as productivity losses from patients and caregivers, such as work time losses due to treatment seeking or sick days, or value of time losses due to caring patients. These costs items constitute the cost of illness of breast cancer. There has been some literature focusing on describing the economic burdens of breast cancer in Taiwan but the data was a bit otdated. Many gaps still exit in our understanding for the overall impact of breast cancer from the societal perspective. This study sets out to explore the disease burdens and cost of illness of breast cancer in Taiwan in three consecutive years. In the first year, incidence‐based cost of illness approach will be undertaken by identifying a cohort of newly diagnosed patients during 2003‐2005 in the NHI claims data. All medical resources will be traced until death occurred or data is censored, and will be compared with a control group. In the second year, prevalence‐based costs of illness approach will be undertaken to describe the medical resources consumed associated with breast cancer tretment during 2006‐2008 using NHI claims data; out‐of‐pocket payment from patients and family, and productivity losses from patients and caregivers will be estimated by patient interview survey data. In the third year, contingent valuation method will be employed to develop questions to elicit patients’ willingness to pay to avoid the overall conomic and psychosocial burdens from breast cancer from a patient interview survey. Descriptive statistics, X2 tests, logistic regressions and Cox proportional regression will be conducted to describe resource consumed associated with breast cacer and to explore correlates associated with the level of resources consumed.