Economic impact of avoidable cancer deaths caused by diagnostic delay during the COVID-19 pandemic: a national population-based modelling study in England, UK
Ce dossier présente un ensemble d'articles concernant la prise en charge des cancers durant la crise sanitaire liée au COVID-19
Introduction : Delays in cancer diagnosis arose from the commencement of non-pharmaceutical interventions (NPI) introduced in the UK in March 2020 in response to the COVID-19 pandemic. Our earlier work predicted this will lead to approximately 3620 avoidable deaths for four major tumour types (breast, bowel, lung, and oesophageal cancer) in the next 5 years. Here, using national population-based modelling, we estimate the health and economic losses resulting from these avoidable cancer deaths. We also compare these with the impact of an equivalent number of COVID-19 deaths, to understand the welfare consequences of the different health conditions.
Methods : We estimate health losses using quality-adjusted life years (QALYs) and lost economic productivity using the human capital (HC) approach. The analysis uses linked English National Health Service (NHS) cancer registration and hospital administrative datasets for patients aged 15-84 years, diagnosed with breast, colorectal, and oesophageal cancer between Jan 1 to Dec 31, 2010, with follow-up data until Dec 31, 2014, and diagnosed with lung cancer between Jan 1, to Dec 31, 2012, with follow-up data until Dec 31, 2015. Productivity losses are based on the estimation of excess additional deaths due to cancer at 1, 3, and 5 years for the four cancer types which were derived from a previous analysis using this dataset. 500 random samples drawn from the total number of COVID-19 deaths reported by the Office for National Statistics, stratified by gender, were used to estimate productivity losses for an equivalent number of deaths (n=3620) due to SARS-CoV-2 infection.
Results : We collected data for 32 583 patients with breast cancer, 24 975 with colorectal cancer, 6744 with oesophageal cancer, and 29 305 with lung cancer. We estimate that across the four site specific cancers combined in England alone, additional excess cancer deaths would amount to a loss of 32,700 QALYs (95% CI 31,300-34,100) and productivity losses of £103.8million GBP (73.2 to 132.2) in the next five years. For breast cancer we estimate a loss of 4,100 QALYS (3900-4400), and productivity losses of £23.2m (18.2-28.6); for colorectal cancer 15,000 QALYS (14100-16000) lost and productivity losses of £35.7m (22.4-48.7); for lung cancer 10,900 QALYS (9900-11700) lost and productivity losses of £38.3m (14.0-59.9) for lung cancer; and for oesophageal cancer, 2,700 QALYS (2300-3100) lost and productivity losses of £6.6m (-6-17.6). In comparison the equivalent number of COVID-19 deaths caused approximately 21,450 QALYs lost as well as productivity losses amounting to £76.4m (73.5 – 79.2).
Conclusion : Premature cancer deaths resulting from diagnostic delays during the first wave of the COVID-19 pandemic in the UK will result in significant economic losses. On a per capita basis this impact is in fact greater than that of deaths directly attributable to COVID-19. These results emphasise the importance of robust evaluation of the trade-offs of the wider health, welfare and economic effects of NPI to support both resource allocation and the prioritisation of time-critical health services directly impacted in a pandemic, such as cancer care.
European Journal of Cancer , résumé, 2020