RESUMO
A study was undertaken at Assiut University Hospital in 2004 to describe the processes of service delivery to breast cancer patients and to provide an answer the following question. To what extent are breast cancer services offered cost effective? Cost was estimated by identifying all medical records of breast cancer patients at the General Surgery and at the Oncology Departments for listing the dates admission to inpatient as well as dates of discharge to compute inpatient days at the hospital. Patients receiving chemotherapy were identified from the archived one days admissions at the medical informatics department. The outpatient visits for radiotherapy were also identified from the Oncology Department register for radiotherapy. The WHO estimate of cost of hospital inpatient bed/day and outpatient visit including drugs and investigations was used to estimate the cost of services in Assiut University Hosptial. The estimated total cost of services for 2004 was 572,568 LE. For approximately 201 patients according to number of patients visiting the oncology outpatient for chemotherapy. The average cost /patient was 2848 LE. At each service point different numbers of breast cancer patients were receiving care. Some indirect measures point to the extremely poor stage of the disease for these women; notably more than 50% of the women receiving the radiotherapy are receiving it for palliative care, as they were me astatic patients. Effectiveness in term of survival was not possible to compute as medical records for inpatients are archived only for three years with the current expenditure levels, and lack of an information system can easily link elements and details of care provided with patient outcome, improvements in quality of care are not possible