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The European Journal of Health Economics
Published in: The European Journal of Health Economics 4/2012

01-08-2012 | Original Paper

Cost of care for colorectal cancer in Ireland: a health care payer perspective

Authors: L. Tilson, L. Sharp, C. Usher, C. Walsh, Whyte S, A. O’Ceilleachair, C. Stuart, B. Mehigan, M. John Kennedy, P. Tappenden, J. Chilcott, A. Staines, H. Comber, M. Barry

Published in: The European Journal of Health Economics | Issue 4/2012

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Abstract

Objective

Management options for colorectal cancer have expanded in recent years. We estimated average lifetime cost of care for colorectal cancer in Ireland in 2008, from the health care payer perspective.

Method

A decision tree model was developed in Microsoft EXCEL. Site and stage-specific treatment pathways were constructed from guidelines and validated by expert clinical opinion. Health care resource use associated with diagnosis, treatment and follow-up were obtained from the National Cancer Registry Ireland (n=1,498 cancers diagnosed during 2004–2005) and three local hospital databases (n=155, 142 and 46 cases diagnosed in 2007). Unit costs for hospitalisation, procedures, laboratory tests and radiotherapy were derived from DRG costs, hospital finance departments, clinical opinion and literature review. Chemotherapy costs were estimated from local hospital protocols, pharmacy departments and clinical opinion. Uncertainty was explored using one-way and probabilistic sensitivity analysis.

Results

In 2008, the average (stage weighted) lifetime cost of managing a case of colorectal cancer was €39,607. Average costs were 16% higher for rectal (€43,502) than colon cancer (€37,417). Stage I disease was the least costly (€23,688) and stage III most costly (€48,835). Diagnostic work-up and follow-up investigations accounted for 4 and 5% of total costs, respectively. Cost estimates were most sensitive to recurrence rates and prescribing of biological agents.

Conclusion

This study demonstrates the value of using existing data from national and local databases in contributing to estimating the cost of managing cancer. The findings illustrate the impact of biological agents on costs of cancer care and the potential of strategies promoting earlier diagnosis to reduce health care resource utilisation and care costs.
Footnotes
1
The proportions for each site and stage are derived by summing the probabilities for adjuvant chemotherapy (without radiotherapy) in the decision trees (Fig. 2). For example: The proportion of Stage II RC patients that receive adjuvant chemotherapy was estimated as follows: (0.044 + 0.129 + 0.034) = 21%.
 
Literature
1.
Jansman, F., Postma, M., Brouwers, J.: Cost considerations in the treatment of colorectal cancer. Pharmacoeconomics 25, 537–562 (2007)CrossRefPubMed
2.
Brown, M., Riley, G., Potosky, A., Etzioni, R.: Obtaining long-term disease specific costs of care: application to medicare enrollees diagnosed with colorectal cancer. Med. Care 37, 1249–1259 (1999)CrossRefPubMed
3.
Clerc, L., Joosts, V., Lejeune, C., et al.: Cost of care of colorectal cancers according to health care patterns and stage at diagnosis in France. Eur J Health Econ 9, 361–367 (2008)CrossRefPubMed
4.
Warren, J., Yabroff, K., Meekins, A., Topor, M., Lamont, E., Brown, M.: Evaluation of trends in the cost of initial cancer treatment. J. Natl Cancer Inst. 100, 888–897 (2008)CrossRefPubMed
5.
Benson, A.: Epidemiology, disease progression, and economic burden of colorectal cancer. J Manag Care Pharm 13, S5–S18 (2007)PubMed
6.
Delco, F., Egger, R., Bauerfeind, P., Beglinger, C.: Hospital health care resource utilisation and costs of colorectal cancer during the first 3-year period following diagnosis in Switzerland. Aliment. Pharmacol. Ther. 21, 615–622 (2005)CrossRefPubMed
7.
Jonnson, B., Wilking, N.: A global comparison regarding patient access to cancer drugs. Ann. Oncol. 18(Suppl 3), 1–77 (2007)
8.
Kanavos, P., Schurer, W.: The burden of colorectal cancer: prevention, treatment and quality of services. Eur J Health Econ 10(Suppl 1), S1–S3 (2010)CrossRefPubMed
9.
Kanavos, P., Schurer, W.: The dynamics of colorectal cancer management in 17 countries. Eur J Health Econ 10(Suppl 1), S115–S129 (2010)CrossRefPubMed
10.
Parkin, D.M., Bray, F., Pisani, P.: Global cancer statistics, 2002. CA Cancer J Clin 55, 74–108 (2005)CrossRefPubMed
11.
12.
National Cancer Registry. Trends in Irish cancer incidence 1994–2002, with projections to 2020. Report of the National Cancer Registry, Cork, Ireland (http://​www.​ncri.​ie), 2006. Accessed April 2010
13.
Verdecchia, A., Guzzinati, S., Francisci, S., et al.: EUROCARE working group survival trends in European cancer patients diagnosed from 1988 to 1999. Eur. J. Cancer 45, 1042–1066 (2009)CrossRefPubMed
14.
Kuhry, E., Schwenk, W., Gaupset, R., Romild, U., Bonjer, J.: Long-term outcome of laparoscopic surgery for colorectal cancer: a cochrane systematic review of randomised controlled trials. Cancer Treat. Rev. 34, 498–504 (2008)CrossRefPubMed
15.
Salz, T., Sander, R.S.: The effect of hospital and surgeon volume on outcomes for rectal cancer surgery. Clin Gastroenterol Hepatol 6, 1185–1193 (2008)CrossRefPubMed
16.
Colorectal Cancer Collaborative Group: Adjuvant radiotherapy for rectal cancer: a systematic overview of 8, 507 patients from 22 randomised trials. Lancet 358, 1291–1304 (2001)CrossRef
17.
Sauer, R., Becker, H., Hohenberger, W., et al.: Preoperative versus postoperative chemoradiotherapy for rectal cancer. N. Engl. J. Med. 351, 1731–1740 (2004)CrossRefPubMed
18.
19.
Australian Cancer Network Colorectal Cancer Guidelines Revision Committee: Guidelines for the prevention, early detection and management of colorectal cancer, 2nd edn. The Cancer Council Australia and Australian Cancer Network, Sydney (2005)
20.
National Institute for Health and Clinical Excellence. Guidance on the use of capecitabine and tegafur with uracil for metastatic colorectal cancer. NICE Technology Appraisal 61 (http://​www.​nice.​org.​uk), 2003. Accessed March 2010
21.
National Institute for Health and Clinical Excellence. Irinotecan, oxaliplatin and raltitrexed for the treatment of advanced colorectal cancer. Review of technology appraisal 33.Technology Appraisal 93 (http://​www.​nice.​org.​uk), 2005. Accessed March 2010
22.
Gravalos, C., Garcia-Escobar, I., Garcia-Alfonso, P., Cassinello, J., Malon, D., Carrato, A.: Adjuvant chemotherapy for stages II, III and IV of colon cancer. Clin. Transl. Oncol. 11, 526–533 (2009)CrossRefPubMed
23.
Andre, T., Sargent, D., Tabernero, J., et al.: Current issues in adjuvant treatment of stage II colon cancer. Ann. Surg. Oncol. 13, 887–898 (2006)CrossRefPubMed
24.
Rajpal, S., Venook, A.P.: Targeted therapy in colorectal cancer. Clin Adv Hematol Oncol 4, 124–132 (2006)PubMed
25.
Health Information and Quality Authority. A health technology assessment of a population-based colorectal cancer screening programme in Ireland (http://​www.​hiqa.​ie), 2009. Accessed April 2010
26.
27.
28.
29.
Segnan, N., Senore, C., Andreoni, B., et al.: SCORE 2 Working Group-Italy. Baseline findings of the Italian multicenter randomised controlled trial of “once-only sigmoidoscopy”. J. Natl Cancer Inst. 94, 1763–1772 (2005)CrossRef
30.
Shah, H., Paszat, L., Saskin, R., Stukel, T., Rabeneck, L.: Factors associated with incomplete colonoscopy: a population-based study. Gastroenterology 132, 2297–2303 (2007)CrossRefPubMed
31.
Di Gregorio, C., Benatti, P., Losi, L., et al.: Incidence and survival of patients with Dukes’ A (stages T1 and T2) colorectal carcinoma: a 15-year population-based study. Int. J. Colorectal Dis. 20, 147–154 (2005)CrossRefPubMed
32.
Kapiteijn, E., Marijnen, C.A., Colenbrander, A.C., et al.: Local recurrence in patients with rectal cancer diagnosed between 1988 and 1992: A population-based study in the west Netherlands. Eur. J. Surg. Oncol. 24, 528–535 (1998)CrossRefPubMed
33.
Manfredi, S., Bouvier, A., Lepage, C., Hatem, C., Dancourt, V., Faivre, J.: Incidence and patterns of recurrence after resection for cure of colonic cancer in a well defined population. Br. J. Surg. 93, 1115–1122 (2006)CrossRefPubMed
34.
Påhlman, L., Bohe, M., Cedermark, B., et al.: The Swedish rectal cancer registry. Br. J. Surg. 94, 1285–1292 (2007)CrossRefPubMed
35.
Sjovall, A., Granath, F., Cedermark, B., Glimelius, B., Holm, T.: Loco-regional recurrence from colon cancer: A population-based study. Ann. Surg. Oncol. 14, 432–440 (2007)CrossRefPubMed
36.
Wibe, A., Carlsen, E., Dahl, O., et al.: Nationwide quality assurance of rectal cancer treatment. Colorectal Dis 8, 224–229 (2006)CrossRefPubMed
37.
Heriot, A., Kumar, D.: Rectal cancer recurrence: factors and mechanisms. Colorectal Dis 2, 126–136 (2000)CrossRef
38.
de Zeeuw, N., Keane, F., Neary, P.: Nurse-led protocol driven colorectal cancer follow-up clinic. Mod Med Irish J Clin Med 37, 16–19 (2007)
39.
Tappenden P, Eggington S, Nixon R, Chilcott J, Sakai H, Karnon J.: Colorectal cancer screening options appraisal: cost-effectiveness, cost-utility and resource impact of alternative screening options for colorectal cancer. Report to the English Bowel Cancer Working Group (2004)
40.
Tappenden, P., Chilcott, J., Eggington, S., Sakai, H., Karnon, J., Patnick, J.: Option appraisal of population-based colorectal cancer screening programmes in England. Gut 56, 677–684 (2007)CrossRefPubMed
41.
42.
Health Service Executive (HSE) Casemix Unit: Ready reckoner of acute hospital inpatient activity and costs (summarised by DRG) relating to 2006 costs and activity. Annual Report Part 3. (2008)
43.
44.
Guest, J., Ruiz, F., Greener, M., Trotman, I.: Palliative care treatment patterns and associated costs of healthcare resource use for specific advanced cancer patients in the UK. Eur J Cancer Care 15, 65–73 (2006)CrossRef
45.
Monthly Index of Medical Specialities (MIMS): Ireland. (August 2008)
46.
National Cancer Registry. Cancer in Ireland, 1994 to 1998: incidence, mortality, treatment and survival. Report of the National Cancer Registry, Cork, Ireland (http://​www.​ncri.​ie), 2001. Accessed April 2010
47.
Neymark, N., Adriaenssen, I.: The costs of managing patients with advanced colorectal cancer in 10 different European centres. Eur. J. Cancer 35, 1789–1795 (1999)CrossRefPubMed
48.
Timmons, A., Sharp, L., Carsin, A.E., et al.: The cost of having cancer: a survey of patients with cancer in Ireland. J. Epidemiol. Community Health 63(Suppl 2), 46 (2009)CrossRef
49.
Drolet, M., Maunsell, E., Mondor, M., et al.: Work absence after breast cancer diagnosis: a population-based study. CMAJ 173, 765–771 (2005)CrossRefPubMed
50.
Bradley, C.J., Oberst, K., Schenk, M.: Absenteeism from work: the experience of employed breast and prostate cancer patients in the months following diagnosis. Psychooncology 15, 739–747 (2006)CrossRefPubMed
51.
Paramore, L., Thomas, S., Knopf, K., et al.: Estimating costs of care for patients with newly diagnosed metastatic colorectal cancer. Clin Colorectal Cancer 6, 52–58 (2006)CrossRefPubMed
52.
Fireman, B.H., Quesenberry, C.P., Somkin, C.P., et al.: Costs of care for cancer in a health maintenance organisation. Health Care Financ Rev 18, 51–76 (1997)PubMed
53.
Ramsey, S.D., Berry, K., Etzioni, R.: Lifetime cancer-attributable cost of care for long-term survivors of colorectal cancer. Am. J. Gastroenterol. 97, 440–445 (2002)CrossRefPubMed
54.
Bouhier, K., Maurel, J., Lefevre, H., Bouin, M., Asrsene, D., Launoy, G.: Changing practices for diagnosis and treatment of colorectal cancer in Calvados: 1990–1999. Gastroenterol Clin Biol 28, 371–376 (2004)CrossRefPubMed
55.
Van Steenbergen LN, Elferink MA, Krijnen P, et al.: Improved survival of colon cancer due to improved treatment and detection: a nationwide population-based study in The Netherlands 1989–2006. Ann Oncol. 2010 May 3 [Epub ahead of print]
56.
Carsin, A.E., Sharp, L., Cronin-Fenton, D., O’Ceilleachair, A., Comber, H.: Inequity in colorectal cancer treatment and outcomes: a population-based study. Br. J. Cancer 99, 266–274 (2008)CrossRefPubMed
57.
Schrag, D.: The price tag on progress: chemotherapy for colorectal cancer. NEJM 351, 317–319 (2004)CrossRefPubMed
58.
Patil, D., Fraser, C., Plesec, T.: KRAS testing and its importance in colorectal cancer. Curr Oncol Rep 12, 160–167 (2010)CrossRefPubMed
59.
Feliu, J., Safont, M.J., Salud, A., Losa, F., Garcia-Giron, C., et al.: Capecitabine and bevacizumab as first-line treatment in elderly patients with metastatic colorectal cancer. Br. J. Cancer 102, 1468–1473 (2010)CrossRefPubMed
Metadata
Title
Cost of care for colorectal cancer in Ireland: a health care payer perspective
Authors
L. Tilson
L. Sharp
C. Usher
C. Walsh
Whyte S
A. O’Ceilleachair
C. Stuart
B. Mehigan
M. John Kennedy
P. Tappenden
J. Chilcott
A. Staines
H. Comber
M. Barry
Publication date
01-08-2012
Publisher
Springer-Verlag
Published in
The European Journal of Health Economics / Issue 4/2012
Print ISSN: 1618-7598
Electronic ISSN: 1618-7601
DOI
https://doi.org/10.1007/s10198-011-0325-z

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