Infertility costs and associated factors in childhood cancer survivors: the role of radiotherapy.
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PURPOSE: This retrospective cohort study estimated the healthcare expenditure of infertility treatment in women who survived childhood cancer and analyzed associated factors using data from the French Childhood Cancer Survivor Study (FCCSS) cohort. PATIENTS AND METHODS: From 2578 women in the FCCSS cohort, 118 exposed who received infertility treatment, aged 18-42, were identified based on first recorded drug therapy and/or in vitro fertilization/intracytoplasmic sperm injection and/or medically assisted procreation between 2011 and 2018. Six hundred eight unexposed who had not undergone infertility treatment were selected using propensity score matching. Expenditure related to infertility treatment was estimated as the difference between cases' expenditures and average expenditures of their controls yearly, over a maximum follow-up period of 4 years unexposed. RESULTS: Average annual expenditure related to infertility treatment per patient over 4 years was 3043 euros (95% CI: 2240; 3845) (in euros 2025). Expenditure peaked during the first 2 years and among women aged 25-35. Patients treated with radiotherapy alone had higher average annual expenditure of 4531 euros (95% CI: 1781; 7281). In multivariate analysis, radiotherapy alone and chemotherapy alone were associated with increased annual expenditure of 4382 euros (95% CI: 1102.0; 7661.3) and 2018 euros (95% CI: 97.3; 3937.8), respectively, compared to patients without childhood radiotherapy or chemotherapy. Combined radiotherapy and chemotherapy increased infertility-related expenditure (€2132.5 (95% CI: -36.6; 4301.6), p: 0.054) compared with patients who received neither of these two treatments. The magnitude, trends of expenditure, and age at initiation of infertility treatment were consistent with the general population. CONCLUSION IMPLICATIONS FOR CANCER SURVIVORS: The study shows that childhood cancer treatment modalities significantly influence expenditures related to infertility treatment in women, which are implicitly attributable to the adverse effects of these treatments,with radiotherapy being a key driver. These findings support developing public health strategies promoting more targeted paediatric cancer treatments to mitigate long-term costs, particularly those associated with infertility treatment.