Time-Driven Activity Based Costing of Advanced Ovarian Cancer From the Perspective of a Brazilian Public Hospital

OBJECTIVES: Ovarian cancer is the most lethal gynecological tumor in Brazil. This study assesses the cost of advanced high-grade serous ovarian cancer (HGSOC), from the perspective of a Brazilian public reference hospital.

METHODS: Retrospective cohort study of women newly diagnosed with HGSOC, stage III/IV, treated at the National Cancer Institute (INCA). A bottom-up micro-costing method was applied, using the time-driven activity-based cost (TDABC) approach. All patients were diagnosed in 2017 and followed-up for up to 5 years. Resource data were obtained from medical charts and aggregated. Unit costs were extracted from official databases: Health Price Bank (BPS) for drug and hospital supplies, SUS Management System (SIGTAP) for surgeries and medical tests and National Union of Federal Public Servants in Science and Technology (SINDCT) for human resource costs. Findings were validated by 68 healthcare professionals and managers via expert panel. Costs were converted from Brazilian currency (BRL) to US dollars (USD) (exchange rate: 1 USD = 0.19 BRL (06/2021)). This study was approved by the Research Ethics Committee (CAAE:95157018.9.0000.5274).

RESULTS: From 110 ovarian cancer patients, 27 were stage III/IV HGSOC, platinum-based chemotherapy responders. The average total cost per patient was BRL 184.166,32 (USD 34,991.60) (median follow-up 35.3 months), with 78.16% spent in the first two years. Hospitalizations and end-of-life care were the highest costs: 49% and 30%, respectively. The main reasons for admissions were surgery related and its complications (47%) and disease progression (26%), followed by clinical complications related to chemotherapy treatment (17%) and toxicity (5%). For all cases, the chemotherapy costs were higher than the Ministry of Health’s reimbursement value (APAC-ONCO).

CONCLUSIONS: The main economic burden in HGSOC is related to the need of effective therapies to reduce disease progression and cumulative chemo-related toxicity. It is essential to review investments in this disease to effectively allocate resources and optimize costs.