Estimation of the Impact of COVID-19 Pandemic Lockdowns on Breast Cancer Deaths and Costs in Poland using Markovian Monte Carlo Simulation 

Magdalena Dul, Michal K. Grzeszczyk, Ewelina Nojszewska, Arkadiusz Sitek

This study examines the effect of COVID-19 pandemic and associated lockdowns on access to crucial diagnostic procedures for breast cancer patients, including screenings and treatments. To quantify the impact of the lockdowns on patient outcomes and cost, the study employs a mathematical model of breast cancer progression. The model includes ten different states that represent various stages of health and disease, along with the four different stages of cancer that can be diagnosed or undiagnosed. The study employs a natural history stochastic model to simulate the progression of breast cancer in patients. The model includes transition probabilities between states, estimated using both literature and empirical data. The study utilized a Markov Chain Monte Carlo simulation to model the natural history of each simulated patient over a seven-year period from 2019 to 2025. The simulation was repeated 100 times to estimate the variance in outcome variables. The study found that the COVID-19 pandemic and associated lockdowns caused a significant increase in breast cancer costs, with an average rise of 172.5 million PLN (95% CI [82.4, 262.6]) and an additional 1005 breast cancer deaths (95% CI [426, 1584]) in Poland during the simulated period. While these results are preliminary, they highlight the potential harmful impact of lockdowns on breast cancer treatment outcomes and costs.