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Costs in primary care of investigating symptoms suspicious of cancer in a defined population.

Journal article
Authors Jörgen Månsson
Bertil Marklund
Per Carlsson
Published in Scandinavian journal of primary health care
Volume 24
Issue 4
Pages 243-50
ISSN 0281-3432
Publication year 2006
Published at Institute of Medicine, School of Public Health and Community Medicine
Pages 243-50
Language en
Keywords cancer, cost of illness, diagnostic activities, family practice, primary health care, symptoms
Subject categories Medical and Health Sciences


OBJECTIVES: To calculate total cost of investigating symptoms related to one of the four most common cancers: prostate, breast, colorectal, and pulmonary. Special attention was given to two non-specific and common symptoms: vertigo/dizziness and tiredness/fatigue. DESIGN: Retrospective examination of patient records in a defined population. SETTING: Primary health care (PHC) and hospital care. MAIN OUTCOME MEASURES: Investigation costs of selected ICD codes. RESULTS: In total 6812 patients with 14,541 ICD codes were investigated to a total cost per registered ICD code, with one of the selected diagnostic measures, of SEK 800. Some 50% of the costs were due to X-ray examinations of which colonic X-ray was the most expensive single procedure. Symptoms related to colorectal cancer were the most expensive to investigate with vertigo/dizziness and tiredness/fatigue examined separately. Tiredness/fatigue symptoms cost SEK 395 and vertigo/dizziness SEK 197 per registered code to investigate and none of them yielded a detected malignancy. The incidence of cancer was 0.7%. The average cost of diagnosing one malignancy was SEK 236,700, if all diagnostic activities could be justified only for detection of malignancies. CONCLUSION: A high cost of diagnosing malignancy can be expected and justified, but many symptoms presented in PHC, such as tiredness/fatigue and vertigo/dizziness, have a relatively high investigation cost but detected no case of cancer in this study.

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