Cost implications of unwarranted imaging for distant metastasis in women with early-stage breast cancer in Ontario

  • K. Thavorn The Ottawa Hospital Research Institute; University of Ottawa; Institute for Clinical Evaluative Sciences
  • Z. Wang The Ottawa Hospital Research Institute; University of Waterloo
  • D. Fergusson The Ottawa Hospital Research Institute; University of Ottawa
  • S. van Katwyk The Ottawa Hospital Research Institute
  • A. Arnaout Ottawa Hospital; The Ottawa Hospital Research Institute
  • M. Clemons The Ottawa Hospital Cancer Centre; University of Ottawa
Keywords: Costs, unwarranted imaging for distant metastasis, early-stage breast cancer, Ontario

Abstract

Introduction

Despite the publication of multiple evidence-based guidelines recommending against routine imaging for distant metastasis in patients with early-stage (i/ii) breast cancer, such imaging is frequently performed. The present retrospective cohort study was conducted to estimate the cost of unnecessary imaging tests in women with stage i and ii breast cancer diagnosed between 1 January 2007 and 31 December 2012 in Ontario.

Methods

We obtained patient-level demographic and tumour data from a large provincial dataset. The total cost of unwarranted imaging tests (in 2015 Canadian dollars) was considered to be equal to the sum of imaging costs incurred between 2007 and 2012 and was stratified by disease stage, imaging modality, and body site.

Results

Of the 26,547 identified patients with early-stage breast cancer, 22,811 (85.9%) underwent at least 1 imaging test, with an average of 3.7 tests per patient (3.2 for stage i patients and 4.0 for stage ii patients) over 5 years. At least 1 imaging test was performed in 79.6% of stage i and 92.7% of stage ii patients. During a 5-year period, the cost of unwarranted imaging in patients with early-stage breast cancer ranged from CA$4,418,139 to CA$6,865,856, depending on guideline recommendations.

Conclusions

Our study highlights the substantial cost of excess imaging that could be saved and re-allocated to patient care if evidence-based guidelines are followed. Future studies should assess strategies to ensure that evidence-based guidelines are followed and to increase awareness of the cost implications of nonadherence to guidelines. 

Author Biographies

K. Thavorn, The Ottawa Hospital Research Institute; University of Ottawa; Institute for Clinical Evaluative Sciences
Clinical Epidemiology Program; School of Epidemiology, Public Health and Preventive Medicine;
Z. Wang, The Ottawa Hospital Research Institute; University of Waterloo
Clinical Epidemiology Program; Department of Statistics and Actuarial Science
D. Fergusson, The Ottawa Hospital Research Institute; University of Ottawa
Clinical Epidemiology Program; School of Epidemiology, Public Health and Preventive Medicine
S. van Katwyk, The Ottawa Hospital Research Institute
Clinical Epidemiology Program,
A. Arnaout, Ottawa Hospital; The Ottawa Hospital Research Institute
Division of Surgical Oncology, Department of Surgery; Cancer Therapeutics Program
M. Clemons, The Ottawa Hospital Cancer Centre; University of Ottawa
Division of Medical Oncology; Department of Medicine
Published
2016-01-05
How to Cite
Thavorn, K., Wang, Z., Fergusson, D., van Katwyk, S., Arnaout, A., & Clemons, M. (2016). Cost implications of unwarranted imaging for distant metastasis in women with early-stage breast cancer in Ontario. Current Oncology, 23, S52-S55. https://doi.org/10.3747/co.23.2977
Section
Canadian Cancer Costing Research