INTRODUCTION: There is a widespread belief among medical specialists in Russia, that increase in the proportion of breast cancer (BC) cases detected on early stages would lead to the substantial decrease in BC costs in the following years, thus all screening interventions are considered as cost-saving.

OBJECTIVES:

To estimate the impact of the increase of the proportion of early BC cases on costs and outcomes for the cohort of women 50-54 years old

METHODS:

We developed a model to assess lifelong costs and outcomes for the cohort of patients diagnosed with BC in 2014 at age of 50-54 (7,450 cases, 69.1% with stage I-II). Only direct medical costs (treatment and follow-up) of the BC covered by health care system were estimated, based on federal statistics, cancer registry data and experts’ survey. During the first year, costs and survival for the initial treatment were assessed. Then patients entered Markov model with 3 states: “progression-free”, “progression”, “death” with cycle length of 1 year. Transition probabilities were defined using published data, risk of death in “progression-free” state was assumed to be the same as in general population. At the next step, we estimated costs and outcomes if the proportion of early BC cases would increase by 1% (75 cases diagnosed at stage I-II, instead of IV). Costs and outcomes were discounted at 3,5% rate.

RESULTS:

In the basecase analysis lifelong costs per cohort were €44.04 million and outcome–60,665 life years. Increase in the proportion of early BC cases by 1% resulted in €120,414 decrease in costs during the first year, but at the lifelong horizon costs increased by €110,072, and 513 life years were gained per cohort.

CONCLUSIONS:

The improvement in the survival of BC patients due to earlier diagnosis results in higher lifelong costs, which are not compensated by the lower cost of initial cancer treatment.