Economic productivity loss due to breast cancer in Norway – a case control study using the human capital approach

Abstract

We estimate the productivity loss attributable to breast cancer in Norway, using a human capital approach where the value to the national economy of subjects’ labor is estimated through their income. Since the approach takes the viewpoint of the society, it includes reduced labor due to mortality as well as reduction among survivors. A case-control design was used. The Norwegian Cancer Registry identified 2,010 patients aged 45-54 years, with breast cancer as their first life-long malignancy diagnosis in 1992-1996. Statistics Norway matched these with random controls of the same age, marital status and municipality residency, and provided data on pension qualifying income until the year 2005, inflation adjusted to 2012 €. The effect of the cancer diagnosis on income throughout the follow-up period was estimated as the difference between the cases’ and controls’ income, corrected for systematic differences between cases and controls before the diagnosis. A quadratic curve approximation was used to estimate effects after the 13 years follow-up period, and a bootstrap resampling approach was applied to compute confidence intervals (CI). Regression modeling was used to estimate life-long productivity loss as a function of age at diagnosis. This was combined with the current Norwegian age distribution of breast cancer incidence, to estimate the national productivity loss due to breast cancer. For our cohort, the 13-years productivity loss attributable to the diagnosis was estimated to 102,600 € per case, with 95% CI (88,500, 116,700). The life-long estimate was 119,200 €, CI (95,400, 155,600). The annual national productivity loss was estimated to 179,900,000 €, or 58,200 € per case. For those aged < 65 at diagnosis, the estimate was 94,300 € per case. The estimated life-long productivity loss depends heavily on the age at diagnosis. The results can be used for evaluating the societal economic benefit from breast cancer prevention programs.

Published: Online December 2017. In print December 2017.