Ireland has a mixed model of healthcare delivery with a public healthcare system funded by general taxation and a large private healthcare insurance system, covering 43% of the population in 2012 and 2016. We set out to examine disparities in outcomes among patients with breast cancer treated in a private hospital compared to national outcomes over a comparable period.
Medical records of patients diagnosed with early (Stage 1-3 as per AJCC version 5) breast cancer between 2010 and 2015 at Bon Secours Hospital, Cork, Ireland were reviewed. Staging was confirmed and 5-year disease specific survival (DSS) and overall survival (OS) were calculated. DSS was compared to 5-year net survival (NS) figures from the National Cancer Registry of Ireland (NCRI) for a comparable period (2010-2014).
DSS (Bon Secours) and NS (NCRI) are summarized in Table. 5 year survival figures are numerically higher in the private hospital compared with national data for each individual stage. Taking stages 1 to 3 combined, the 95% confidence intervals do not cross each other, indicating statistical significance.
Stage Bon Secours (DSS) NCRI (NS) DSS 95% CI NS 95% CI 1 100 96.5-100 98 97.2-98.9 2 95.2 90.6-97.1 90.9 89.9-91.8 3 89.5 70.5-96.5 71.5 69.2-73.9 1-3 combined 97 93.9-97.8 90.4 90.0-91.4
We found evidence of superior outcomes in patients with early breast cancer treated at a private hospital compared with national outcome figures. This was demonstrated in ‘all comers’ (stages 1-3 combined), and particularly in patients with stage 3 breast cancer. Potential reasons for this disparity include differences in socioeconomic status, health-seeking behaviours and/or underlying health status between the two populations included. Differences in extent or timeliness of access to therapies may also contribute.
Bon Secours Hospital Cork.
Has not received any funding.
All authors have declared no conflicts of interest.