Medical costs of cancer attributable to work in the Basque Country (Spain) in 2008

Our plain-English summary of Medical costs of cancer attributable to work in the Basque Country (Spain) in 2008, by M. García Gómez, R. Castañeda López, R. Urbanos Garrido, et al (Gaceta Sanitaria, 2013).

The study

• Authors: M. García Gómez, R. Castañeda López, R. Urbanos Garrido, P. López Menduiña, S. Markowitz
• Journal: Gaceta Sanitaria
• Published: 2013;27(4):310-7
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objectives: [corrected] Underreporting of work-related cancer in the Basque Country (Spain) is massive. The aim of our study is to estimate the job-related cancer in the Basque Country in 2008 treated by the Basque Public Health System-Osakidetza, as well as the medical costs derived from its treatment in the same year.

Methods: Scientific evidence from industrialised countries is used to estimate the number of processes of cancer attributable to work. Medical costs for specialised care (outpatient and hospital admissions) are derived from the National Health System cost accounts. Costs due to primary health care and pharmaceutical benefits are obtained from Spanish secondary sources. Figures were computed according to disease and sex.

Results: We estimate 1,331 work-attributable cancers hospitalizations and 229 work-attributable cancers specialized ambulatory cases. Medical costs borne by public health care system exceed 10 million euros. Specialized care accounts for 64.2% of the total cost. Bronchus and lung cancer represents the largest percentage of total expenditure (27%), followed by the bladder cancer (12.6%), mesothelioma (8.6%), the colon cancer (7.3%), and stomach (6.7%).

Conclusions: The magnitude of cancer attributable to work in the Basque Country is much higher than reflected in the official Registry of Occupational Diseases. Underreporting of work-related cancers hampers prevention and shifts funding of medical costs from social security to the tax-financed public health system.

Copyright © 2012 SESPAS. Published by Elsevier Espana. All rights reserved.

In plain English

This study estimated how many cancers treated in the Basque public health system (Osakidetza, Spain) in 2008 could be attributed to work, and what treating them cost. It did not examine individual workers or measure exposures. The authors applied published estimates of the share of cancers caused by occupational exposures, mostly from studies in other industrialized countries, to 2008 hospital and specialized outpatient records for people aged 25 or older. Of 17,743 cancer hospitalizations, a median of 1,331 (range 639 to 3,371) were estimated to be work-attributable, as were a median of 229 of 3,058 outpatient cases. For mesothelioma, 74 of 82 hospital discharges in men and 10 of 41 in women were counted as work-attributable. Estimated medical costs totaled 10.26 million euros, 8.54% of Basque public cancer spending. Lung cancer accounted for 27% of these costs, bladder 12.6%, mesothelioma 8.6%, colon 7.3% and stomach 6.7%. The authors concluded that work-related cancer is far more common than official records show, and that its costs fall on the tax-financed health system. They considered their figures likely underestimates.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Cost-of-illness estimate: published occupational attributable fractions from other countries were applied to Basque hospital and outpatient databases for 2008 (prevalence approach, direct medical costs only)
• Who was studied: Cancer hospital discharges (17,743) and specialized ambulatory cases (3,058) among people aged 25 or older treated in Basque public hospitals (Osakidetza) in 2008
• Exposure: Occupational exposures to carcinogens in general, estimated through attributable fractions rather than measured. No fiber types, products or doses were studied. In the discussion, the authors mention asbestos as the near-exclusive cause of mesothelioma.
• Main results:
  • Work-attributable cancer hospitalizations in the Basque public system in 2008: range 639 to 3,371, median 1,331
  • Of 3,058 specialized outpatient cancer cases, between 110 and 581 (median 229) were estimated to be attributable to work
  • Mesothelioma, using the Finnish attributable fractions of 90% (men) and 25% (women): 74 of 82 hospital discharges in men and 10 of 41 in women were estimated as work-attributable
  • Total estimated medical cost of work-related cancers in people 25 or older was 10.26 million euros, 8.54% of total Basque public expenditure on cancer
  • Hospital-related (specialized) care made up 64.2% of costs, pharmaceutical care 33.5% and primary care 2.3%
  • Share of total cost by cancer: bronchus and lung 27% (mainly in men), bladder 12.6%, mesothelioma 8.6%, colon 7.3%, stomach 6.7%. Table 5 gives the mesothelioma total as 881,150.56 euros.
  • Hospital costs for work-related cancers were eight-fold higher in men than in women
  • For comparison, the authors cite 11 occupational cancer cases reported by the social security system in 2008
• The authors' conclusion: The authors concluded that work-attributable cancer in the Basque Country is much greater than the official Registry of Occupational Diseases shows. In their view, underreporting hampers prevention and shifts medical costs from social security to the tax-financed public health system.
• Limitations the authors state:
  • Attributable fractions came from studies in other countries
  • Not all cancers were included in the Finnish study, so the number of work-attributable cases is likely underestimated
  • Indirect costs (productivity losses, sick leave) and non-health costs such as caregivers were not included
  • Outpatient data covered only 46.7% of day-hospital medical activity, leading to underestimated costs
  • Primary care and pharmacy costs were based on Catalan budget data, which assumes Catalonia and the Basque Country have similar cost structures

Topics

Medical terms in this study, explained in our Lexicon: Bronchus, Lung Cancer, Mesothelioma, Colorectal Cancer, Occupational Disease.

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