Methods: Surviving PC patients residing in selected urban, suburban, and remote communities in Ontario, Canada, and diagnosed in 1993-4, 1997-8 or 2001-2, were selected from the Ontario Cancer Registry (n = 1961). Consenting patients were mailed a self-report questionnaire asking about health care and lost time associated with PC during the previous 6 months in eight key areas: 1. healthcare professional visit time, OPC, and accompanying person; 2. medication use and OPC; 3. equipment purchased and OPC; 4. community service use and OPC; 5. employment time lost; 6. problems with household chores and OPC for paid help; 7. leisure time lost; and 8. health care insurance. Time was valued according to the average hourly wage rate in 2006 in Canada. Self-reported data were doubled to approximate annual values.

Results: 670 patients returned completed questionnaires. The mean annual OPC and TC of PC care was $1093/patient. Mean annual OPC were estimated to be $349/patient. Patients incurred an average of $319 annually for health professional visits and diagnostic tests and $30 towards other costs (e.g. transportation, parking). Sixty-nine percent (n = 462) of patients visited at least one healthcare professional; 43% visited an urologist, 18% visited a family physician, and 15% visited a radiation oncologist. The mean annual OPC for visiting a health professional covered by the Ontario Health Insurance Plan ranged from $56 – 62/patient. Individuals who visited a radiation oncologist incurred the greatest mean annual TC ($289), followed by patients who visited an urologist ($223) and family physician ($151). Only 26% of patients were employed for pay; 5 patients reported difficulty working. Mean annual productivity loss was estimated at $225 per patient.

Conclusions: TC associated with work loss does not represent a major economic burden among PC patients because a minority are working, and impact among those who are working is modest. OPC, in a country with universal health insurance, is similar in magnitude to the annual attributable direct medical costs among stable PC outpatients ($349 vs. $303). Data from this study will be used, along with outcome data gathered from the same patients, to develop a Canadian PC policy model.