Appendix Table A
Cost input parameters and resource utilization Appendix Table A
Cost input parameters and resource utilization

Table A
Cost input parameters and resource utilization
Table summary
This table displays the results of Cost input parameters and resource utilization. The information is grouped by Variables (appearing as row headers), Definitions and descriptions, Resource utilization (RU) and Cost (2012 CAN$) (appearing as column headers).
Variables	Definitions and descriptions	Resource utilization (RU)	Cost (2012 CAN$)
Screening and diagnosis
Breast cancer screening program	RU: Assume all eligible women would be screened Cost: Includes mammography physician^{Note 31}	100% of women eligible for screening	$183.00 per screen
Non-invasive work-up	RU: Assume all women with a positive mammogram Cost: Includes work-up mammography, radiology, physician clinic visit^{Note 31}	100% of women with positive screening exam	$445.95 per work-up
Invasive work-up (needle biopsy)	RU: 14.7% of women who get non-invasive work-up receive invasive procedure^{Note 32} Cost: physician clinic visit, needle biopsy, pathology^{Note 31}	82.1% of women who receive invasive work-up	$745.46 per work-up
Invasive work-up (excisional)	RU: 14.7% of women who get non-invasive work-up receive invasive procedure^{Note 32} Cost: physician clinic visits, excision, pathology^{Note 31}	17.8% of women who receive invasive work-up	$1,652.44 per work-up
Treatment
Chemotherapy	RU: Percentage of women receiving chemotherapy Cost: Mean value of first-, second- and third-generation chemotherapies^{Note 33}^{Note 34}	Women receiving chemotherapy with invasive cancer (see below) Women receiving chemotherapy with DCIS = 0% (see below)	$7,376.10 per course
Trastuzumab	RU: Assume all HER2+ women receive Trastuzumab Cost: Treatment costs based on 8 cycles; includes chemotherapy costs recommended for Trastuzumab (paclitaxel), health care personnel costs and physician clinic visits associated with administration^{Note 33}^{Note 34}^{Note 35}	14% with invasive cancer 0% with DCIS	$29,709 per course
Tamoxifen	RU: Assume use of Tamoxifen for appropriate population for 10 years Cost: Annual cost (excludes markup and dispensing) + physician clinic visit 4 times per year^{Note 36}	100% for invasive cancer in eligible women 100% for DCIS in eligible women	$383.40 per annum
Aromatase inhibitors (AI)	RU: Assume use of AI for appropriate population for 10 years Cost: Annual cost of letrozole (excludes markup and dispensing) + physician clinic visits 4 times per year^{Note 36}	100% for invasive cancer in eligible women 0% for DCIS	$822.40 per annum
Treatment cost per appropriate cohort
ER+, younger than 50, DCIS, annual cost	RU: Tamoxifen only (for 10 years) Cost: Tamoxifen only^{Note 36}	100%	$383.40
ER+, younger than 50, invasive, annual cost	RU: Tamoxifen (for 10 years) + chemotherapy Cost: Tamoxifen (for 10 years) + chemotherapy^{Note 33}^{Note 34}^{Note 36}	100%	$7,759.50
ER+, younger than 50, invasive, annual cost with Trastuzumab	RU: Tamoxifen (for 10 years) + chemotherapy + Trastuzumab Cost: Tamoxifen (for 10 years) + chemotherapy + Trastuzumab^{Note 33}^{Note 34}^{Note 36}	100%	$37,462.50
ER+, 50 or older, DCIS, annual cost	RU: Tamoxifen only (for 10 years) Cost: Tamoxifen only^{Note 36}	100% of women in this cohort received this regimen	$383.40
ER+, 50 or older, invasive, annual cost	RU: Chemotherapy + AI (for 10 years) Cost: Chemotherapy + AI (for 10 years)^{Note 33}^{Note 34}^{Note 36}	100% of women in this cohort received this regimen	$8,198.50
ER+, 50 or older, invasive, annual cost with Trastuzumab	RU: Chemotherapy + AI (for 10 years) + Trastuzumab Cost: Chemotherapy + AI (for 10 years) + Trastuzumab^{Note 33}^{Note 34}^{Note 36}	100% of women in this cohort received this regimen	$37,901.50
ER-, younger than 50, DCIS, annual cost	No drug therapy, based on expert opinion	100% of women in this cohort received this regimen	$0
ER-, younger than 50, invasive, annual cost	RU: Chemotherapy Cost: Chemotherapy^{Note 32}^{Note 34}^{Note 36}	100% of women in this cohort received this regimen	$7,376.10
ER-, younger than 50, invasive, annual cost with Trastuzumab	RU: Chemotherapy + Trastuzumab Cost: Chemotherapy + Trastuzumab^{Note 33}^{Note 34}^{Note 36}	100% of women in this cohort received this regimen	$37,079.10
ER-, 50 or older, DCIS, annual cost	No drug therapy, based on expert opinion	100% of women in this cohort received this regimen	$0
ER-, 50 or older, invasive, annual cost	RU: Chemotherapy Cost: Chemotherapy^{Note 33}^{Note 34}	100% of women in this cohort received this regimen	$7,376.10
ER-, 50 or older, invasive, annual cost with Trastuzumab	RU: Chemotherapy + Trastuzumab Cost: Chemotherapy + Trastuzumab^{Note 33}^{Note 34}^{Note 36}	100% of women in this cohort received this regimen	$37,079.10
Procedures
Radiation for invasive cancer	RU: Percentage of women with breast cancer who received radiation therapy^{Note 8} Cost: 25 fractions * $138 (1996) or $188.39 (2012)^{Note 20}^{Note 31}^{Note 37}	67%	$5,014.05 per radiation
Surgery for invasive cancer	RU: Percentage of women with breast cancer receiving surgery^{Note 38}	90%	Costs stratified by lumpectomy and mastectomy
Surgery (lumpectomy for invasive cancer)	RU: Percentage of all women receiving surgery Cost: Ontario Case Costing Initiative (OCCI) 2012^{Note 39}	63% Report by Canadian Institute for Health Information and Canadian Partnership Against Cancer shows wide provincial variation in annual rates for the two treatments.	$4,937.06 per surgery
Surgery (mastectomy for invasive cancer)	RU: Percentage of all women receiving surgery Cost: OCCI 2012^{Note 39}	37% Report by Canadian Institute for Health Information and Canadian Partnership Against Cancer shows wide provincial variation in annual rates for the two treatments.	$6,956.77 per surgery
Radiation for DCIS	RU: Percentage of DCIS women receiving radiation therapy Cost: 25 fractions * $138 (1996) or $188.39 (2012)^{Note 20}^{Note 31}^{Note 37}	50%	$5,014.05 per radiation
Surgery (lumpectomy for DCIS )	RU: Percentage of DCIS women receiving surgery^{Note 41} Cost: OCCI 2012 ^{Note 39}^{Note 40}^{Note 41}	67%	$4,937.06 per surgery
Surgery (mastectomy for DCIS)	RU: Pecentage of DCIS women receiving surgery Cost: OCCI 2012^{Note 39}^{Note 40}^{Note 41}	33%	$6,956.77 per surgery
Indirect costs
Time off for screening	RU: Assume 4 hours based on travel, appointment and waiting time Cost: $22.87/hour^{Note 42}	100%	$91.48 per time off for screening
Lost productivity in first year	RU: Assume all women working; lost 27% of annual income because of breast cancer treatment^{Note 43} Cost: $22.87/hour^{Note 42}	100%	$12,838.18 per annum
Premature death	RU: Assumption, all women who died Cost: $22.87/hour * 40 hours * 52 weeks^{Note 42}
DCIS = ductal carcinoma in situ ER+/ER- = estrogen receptor status HER2+ = human epidermal growth factor receptor 2

References for Appendix Table A

Footnote 8.

Mittmann N, Porter J, Rangrej J, et al. Health system costs for stage-specific breast cancer: a population-based approach. Current Oncology 2014; 21(6): 281-93.

Return to note 8 referrer

Footnote 20.

Bank of Canada. Inflation Calculator, 2014. Available at: http://www.bankofcanada.ca/rates/related/inflation-calculator/. Accessed July 7, 2014.

Return to note 20 referrer

Footnote 31.

Ministry of Health and Long-Term Care. Schedule of Benefits for Physician Services Act under the Health Insurance Act. Available at: http://www.health.gov.on.ca/english/providers/program/ohip/sob/physserv/physserv_mn.html Accessed July 7, 2014.

Return to note 31 referrer

Footnote 32.

Cancer Care Ontario. Ontario Breast Screening Program 20th Anniversary Report 1990-2010. Available at: https://www.library.yorku.ca/find/Record/2966137. Accessed July 7, 2014.

Return to note 32 referrer

Footnote 33.

Cancer Care Ontario. Drug Formulary. Available at: https://www.cancercare.on.ca/cms/one.aspx?portalId=1377&pageId=10760. Accessed July 7, 2014.

Return to note 33 referrer

Footnote 34.

Personal communication and hospital formulary, Department of Pharmacy,Sunnybrook Health Sciences Centre, 2014.

Return to note 34 referrer

Footnote 35.

ASCO University Lifelong Learning. Available at: http://university.asco.org/locally-advanced-breast-cancer-asco-tumor-board. Accessed July 7, 2014.

Return to note 35 referrer

Footnote 36.

Ministry of Health and Long-Term Care. Ontario Drug Benefit Formulary/Comparative Drug Index. Available at : http://www.health.gov.on.ca/en/pro/programs/drugs/odbf_mn.aspx Accessed July 7, 2014.

Return to note 36 referrer

Footnote 37.

Earle CC, Chapman RH, Baker CS, et al. Systematic overview of cost-utility assessments in oncology. American Society of Clinical Oncology 2000: 18(18): 3302-17.

Return to note 37 referrer

Footnote 38.

Mittmann N, Isogai PK, Saskin R, et al. Population-based home care services in breast cancer: Resources and costs. Current Oncology 2012; 19(6): e383-91.

Return to note 38 referrer

Footnote 39.

Ontario Case Costing Initiative. OCCI Costing Analysis Tool. Available at: http://ophid.scholarsportal.info/details/view.html?q=re&uri=/phirn/occi_PHIRN_e.xml Accessed July 7, 2014.

Return to note 39 referrer

Footnote 40.

Canadian Partnership Against Cancer. Breast Cancer Surgery In Canada, 2007-2008 to 2009-2010. Ottawa: Canadian Institute for Health Information, 2012.

Return to note 40 referrer

Footnote 41.

Personal communication with radiation oncologist. July 7, 2014.

Return to note 41 referrer

Footnote 42.

Statistics Canada. Average hourly wages of employees by selected characteristics and occupation, unadjusted data, by province (monthly) (Canada). Available at: http://www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/labr69a-eng.htm. Accessed July 7, 2014.

Return to note 42 referrer

Footnote 43.

Lauzier S, Maunsell E, Drolet M, et al. Wage losses in the year after breast cancer: Extent and determinants among Canadian women. Journal of the National Cancer Institute 2008; 100(5): 321-32.

Return to note 43 referrer

Date modified:: 2017-07-12

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Appendix Table A
Cost input parameters and resource utilization Appendix Table A
Cost input parameters and resource utilization