Pancreatic cancer, healthcare cost, and loss of productivity: a register-based approach.

BACKGROUND: Despite the fact that pancreatic cancer is the fourth leading cause of cancer-related death, there is little empirical evidence on its direct healthcare costs and, especially, its indirect costs due to loss of production. METHODS: The present study is a retrospective analysis of all patients with pancreatic cancer (excluding endocrine cancer) in the primary catchment area of Lund University Hospital, Sweden, during the period 2005-2007. Detailed information on all diagnostic and therapeutic investigations, interventions, and postoperative course and long-term follow-up was collected, as well as absenteeism from work due to the health problem, from which direct costs were calculated. The indirect costs for loss of production due to sickness and premature death were calculated by the human capital method. A total of 83 patients were included, for an incidence rate of 9.9 patients/100,000 inhabitants. RESULTS: Direct treatment cost per pancreatic-cancer patient was estimated at EUR 16,066 for each patient's remaining lifetime. Hospitalization accounted for the major expenditure-60% of the lifetime treatment cost. Patients with resectable tumor had a mean cost of EUR 19,809; locally advanced disease, EUR 14,899; and metastatic disease, 16,179. Younger patients and men had a higher than average lifetime treatment cost. The loss of productivity was estimated at EUR 287,420 per patient younger than 65 years of age, of which premature mortality accounted for 79%. CONCLUSIONS: Adding the cost of palliative care estimated in a previous Swedish study, health-care costs and productivity losses for pancreatic cancer would add up to a substantial economic burden for Sweden at large in 2009 (population 9.1 million), between EUR 86 million and EUR 93 million.