The present study offers an exhaustive examination of the economic implications of prostate cancer in Iran, underscoring the substantial expenses related to diagnosis, treatment, and follow-up care from diverse viewpoints. In comparison to prior research, our estimates of the direct medical costs are congruent with those documented in other nations. The aggregate direct medical costs in our investigation amounted to $169,860, predominantly influenced by the costs of therapy. This parallels the conclusions drawn by Alinezhad et al., who underscored the considerable direct medical costs borne by patients, albeit they reported a higher uninsured rate of 23.6%, culminating in significant catastrophic healthcare expenditures (6). The aggregate cost per patient in our investigation was approximately $809, markedly lower than the $5,245 median per-patient direct medical costs reported by Alinezhad et al. This discrepancy can be ascribed to variations in methodologies, treatment patterns, and cost conversion practices (6). In a Swedish study conducted by Hao et al., the economic burden of prostate cancer was significantly elevated, with an annual cost estimated at €281 million (13). Direct medical costs constituted 58% of the total, which is lower than the 74% reported in our study. The difference in cost structures can be attributed to the inclusion of informal care and productivity losses in the Swedish study, which accounted for 32% and 10% of the total burden, respectively (14, 15).
Our study discovered that indirect costs, primarily due to patients’ absence from work, totaled $25,935, representing 11% of the total costs. This is in line with the findings from the US study by Gustavsen et al., where productivity losses were a significant component of the economic burden, although they observed that high-risk patients incurred greater costs over time due to disease progression (11). The lower indirect costs in our study compared to other regions could be attributed to the higher age of our patient cohort, as older patients are less likely to be in the workforce (16). Out-of-pocket costs in our study were approximately $21,375, accounting for 9% of the total costs. This is a critical consideration for policymakers, as mechanisms for financial protection need to be fortified to alleviate the financial burden on patients. Alinezhad et al. also underscored the high prevalence of catastrophic healthcare expenditures, suggesting that enhanced coverage and support for patients are warranted (6). The substantial costs associated with prostate cancer, particularly in terms of direct medical expenses, highlight the necessity for improved insurance coverage and financial support for patients. The findings from Eswatini by Ngcamphalala et al. indicate that advanced cancer stages significantly augment healthcare costs, a trend also observed in our study (17). This suggests that early detection and treatment are pivotal in managing overall costs and enhancing patient outcomes (18).
Additionally, the variability in cost estimates and methodologies across different studies underscores the need for standardized approaches to cost analysis. As suggested by previous research, harmonizing methodologies and expanding research in cost-of-illness studies are essential steps towards obtaining more accurate and comparable data.
Conclusion Our study offers a detailed examination of the economic implications of prostate cancer in Iran, with significant ramifications for healthcare policy and patient financial protection. By addressing the identified gaps in insurance coverage and concentrating on early detection and treatment, it is feasible to mitigate the overall economic impact of prostate cancer on patients and society.
Limitations
Our study exhibits several limitations that warrant consideration. These include the potential for misreporting of costs and income, as well as the restricted generalizability of our findings due to the metropolitan focus of our patient cohort. Similar to the observations made by Alinezhad et al. (6), the bottom-up approach employed in our study, while valuable for obtaining direct patient information, may inadvertently lead to a higher likelihood of missing values. To address these limitations, future research endeavors should strive to incorporate a more diverse patient population and explore the utilization of top-down approaches to gather more comprehensive data.