Ovarian cancer (OC) has relatively low prevalence and incidence rates in Spain (11.1 and 10.2 per 100,000 women per year, respectively), but is the second most frequent gynecological cancer and the sixth leading cause of cancer death in Spain. Survival is related to the diseasés stage at time of diagnosis. Epithelial OC represents 90% of total OC cases. Its economic burden in Spain was previously unknown.
We developed a Markov model from a social perspective simulating the natural history of epithelial OC and its four stages, with a 10-year time horizon, 3 week cycles, 3% discount rate, and 2015 €. Healthcare resource utilization and costs were estimated by disease stage. Direct healthcare costs (DHC) included early screening, genetic counselling, medical visits, diagnostic tests, surgery, chemotherapy, hospitalizations, emergency services, and palliative care. Direct non-healthcare costs (DNHC) included formal and informal care. Indirect costs (IC) included labour productivity losses due to temporary and permanent leaves, and premature death. Epidemiological data and resource use in all stages were taken from the literature and validated for Spain by the Ovarcost group (a Spanish multidisciplinary advisory board) using a Delphi process.
The total cost of epithelial OC over 10 years was €2,469 mill: €278 mill (11%) in stage I, €142 mill (6%) in stage II, €1,478 mill (60%) in stage III and €572 mill (23%) in stage IV. Mean total cost per patient per year was €30,098: €9,723€, €16,080, €42,308€ and €44,798 in stages I to IV. Of total costs, 69% were due to DHC, 28% to DNHC and 3.0% to IC. DHC were €162 mill in stage I, €82 mill in stage II, €979 mill in stage III and €487 mill in stage IV. Mean DHC per patient per year was €21,499. DNHC were €60 mill in stage I, €52 mill in stage II, and €490 mill and €85 mill in stages III and IV, respectively. Mean DNHC per patient per year was €7,718.
Epithelial OC imposes a significant burden on the national health system and society as a whole in Spain. Investment in better early diagnosis techniques might increase survival and patientś quality of life, which would likely reduce costs of late stages, leading in turn to a substantial reduction of the economic burden associated with OC.
Clinical trial identification
Legal entity responsible for the study
L. Delgado-Ortega, C. Moya-Alarcón, L. Cordero, A. Gascó: Working in Astrazeneca. Astrazeneca but it has not interfered in the results. A.G. Domínguez, Á. Hidalgo, M. Jiménez, R. Villoro: Astrazeneca has funded the project but has not intervened in the same. J. Borras: Honoraria as an expert consultant to the project. E. González-Haba, S. Menjón, J. Oliva, P. Pérez, D. Vicente: Honoraria as an expert consultant to the project.