Cost of treatment for breast cancer in central Vietnam

Figures & data

Table 1. Treatment patterns for breast cancer in Vietnam, 2001–2006

Stage of diagnosis	Applied treatment
I	Breast surgery, including mastectomy or breast-conserving surgery with/without axillary dissection. Eligible patients received hormone therapy.
II	Mastectomy breast surgery with axillary dissection. Bilateral oophorectomy by surgery or radiation, if pre-menopause. Adjuvant radiation was supplemented with either external radiotherapy to the breast, chemotherapy, or both. Eligible patients also received hormone therapy.
III	Chemotherapy followed by mastectomy with axillary dissection supplemented with adjuvant chemotherapy. External radiotherapy to the breast was also administered and eligible patients received hormone therapy.
IV	Chemotherapy and/or radiation therapy were supplemented with hormone therapy for eligible patients.

Table 2. Characteristics of patients with breast cancer in Hue Central Hospital

Characteristics	Number of patients	Percentage
Age at diagnosis (years)
Mean (SD)	51 (9.5)
Range	33–75
<40	16	12.4
40–49	47	36.4
50–59	42	32.6
60–69	17	13.2
≥70	7	5.4
Residence
Urban	67	51.9
Rural	62	48.1
Health insurance coverage
Yes	68	52.7
No	61	47.3
Stage of breast cancer at diagnosis
I	9	7.0
II	73	56.6
III	35	27.1
IV	12	9.3

Table 3. Compliance with breast cancer treatment in relation to health insurance

	Health insurance coverage (%)
Compliance	Yes (95% CI)	No (95% CI)	Total (95% CI)
Complete compliance	76.5 (64.8–85.2)	68.9 (56.1–79.3)	72.9 (64.4–79.9)
Partial compliance	17.6 (10.2–28.7)	4.9 (1.6–14.4)	11.6 (7.1–18.5)
No compliance	5.9 (2.2–14.8)	26.2 (16.6–38.8)	15.5 (10.2–22.9)

95% CI: 95% confidence interval; p=0.0016 (Pearson's chi-square test).

Fig. 1.  Kaplan–Meier estimates of 5-year survival probability by stage of breast cancer.

Table 4. Cost estimation per category of breast cancer treatment

	Costs (US dollars)
Category	Mean	SD	Median	Range
Diagnosis	16.02	4.93	16.00	6.9–33.20
Treatment
Surgery	82.35	31.82	83.00	0.0–235.70
Chemotherapy	476.48	752.81	379.40	0.0–3772.7
Radiation therapy	22.87	37.57	9.00	0.0–300.60
Hormone therapy	4.25	15.20	0.00	0.0–109.60
Other (supportive medication)	4.50	14.34	0.00	0.0–93.10
Inpatient fee	26.38	12.17	24.60	0.0–88.10
Initial treatment cost	632.85	754.54	509.00	11.7–3955.4
Costs for follow-up care
Supportive treatment	14.06	75.08	0.00	0.0–634.10
Cost for follow-up care	342.18	259.25	409.20	0.0–901.70
Total cost for follow-up care	356.24	260.09	429.40	0.0–901.70
5-Year total cost for treatment course	975.01	730.79	844.20	11.7–3955.4
Annual treatment costs	195.00	146.16	168.80	2.3–791.10

SD, standard deviation; costs are adjusted for inflation to the year 2010; discount rate=3%; exchange rate in July 2010: 1 USD=18,544 VND.

Fig. 2.  The relationship between key characteristics of patients and the total 5-year cost of the course of treatment for breast cancer.

Table 5. Variance in cost of breast cancer treatment according to stage at diagnosis

Cost category	Median	Median difference	P	95% CI
Initial treatment cost
Stage I	128.7	0.0	0.218	−76.86–334.26
Stage II	368.8	240.1	0.032	20.92–459.28
Stage III	684.1	519.4	<0.001	286.74–752.06
Stage IV	537.9	482.2	0.001	208.45–334.26
Follow-up cost
Stage I	409.2	0.0	<0.001	383.91–434.49
Stage II	516.5	107.3	<0.001	80.42–134.18
Stage III	218.4	−109.8	<0.001	−219.43– − 162.17
Stage IV	0.0	−409.2	<0.001	−436.21– − 382.19
Aggregated 5-year total cost
Stage I	568.6	0.0	<0.001	334.74–802.46
Stage II	901.8	333.2	0.009	83.86–582.54
Stage III	816.1	247.5	0.067	−17.19–512.19
Stage IV	603.4	42.30	0.789	−269.13–353.73
Annual treatment cost
Stage I	113.7	0.0	<0.001	66.97–160.43
Stage II	180.4	66.7	0.009	16.88–116.52
Stage III	163.2	49.5	0.066	−3.39–102.39
Stage IV	120.7	8.5	0.787	−53.73–70.73

Cost unit: US dollars.

Table 6. Estimated costs, including the government subsidy and other sources

	Cost category
	5-Year total cost		Annual treatment cost
Coverage of government budget and other sources	Mean	Median	Mean	Median
30%	1392.9	1206	278.57	241.14
40%	1625.0	1407	325.00	281.33
Baseline	975.01	844.20	195.00	168.80

Cost unit: US dollars.