The European Journal of Health Economics

, Volume 9, Issue 4, pp 361–367 | Cite as

Cost of care of colorectal cancers according to health care patterns and stage at diagnosis in France

  • Laurence Clerc
  • Valérie Jooste
  • Catherine Lejeune
  • Bernard Schmitt
  • Patrick Arveux
  • Catherine Quantin
  • Jean Faivre
  • Anne-Marie BouvierEmail author
Original paper


Little is known about the economic burden associated with colorectal cancer in France. The aim of this study was to evaluate the effects of age, stage at diagnosis, health care pattern and level of comorbidities on the mean cost of the management of colorectal cancers, using data from a population-based registry and the French health care system. We estimated the direct costs of medical care for 384 colorectal cancers diagnosed in 2004, using the three main databases of the National Health Insurance. The cost of management was defined as the sum of all health expenditures over the 12 months following the date of diagnosis. The mean cost for first-year management was 24,966€ (SE 1,195€). There was no significant difference in overall costs in relation to sex, age, Charlson index score, cancer location or health care pattern. Costs increased significantly with cancer extension from 17,596€ for stage I to 35,059€ for stage IV. Hospitalisation charges represented the greatest economic burden (55.2%), followed by medical purchases (24.4%), outpatient care (17.8%) and transportation (2.5%). These results confirm the major economic burden of colorectal cancer and indicate that total costs depend mainly on the stage at diagnosis. By improving stage at diagnosis, mass screening could contribute to decreasing the cost of managing colorectal cancers.


Cost of care Colorectal cancer Registry Health care patterns 



We thank all private and public clinicians, and staff in charge of Medical Databases Departments which accepted to collaborate in the rapid designation of incident cases. We thank Didier MENU (Association Régionale des Caisses de la Mutualité Sociale Agricole) for contribution in the completion of the database, Stéphanie Normand for valuable statistical help and Célia Berchi for methodological help. This work was supported by a grant from the ‘Institut National du Cancer’.


  1. 1.
    Belon-Leneutre, M., Schraub, S., Mercier, M.: Evaluation des dépenses de santé au cours des 6 premiers mois après le diagnostic de cancer à partir d’un registre de population. Rev. Epidemiol. Sante Publ. 36, 118–324 (1988)Google Scholar
  2. 2.
    Borie, F., Daures, J.P., Millat, B., Tretarre, B.: Cost and effectiveness of follow-up examinations in patients with colorectal cancer resected for cure in a French population-based study. J. Gastrointest. Surg. 8, 552–558 (2004)CrossRefGoogle Scholar
  3. 3.
    Bouvier, V., Reaud, J.M., Gignoux, M., Launoy, G.: Cost of diagnostic and therapeutic management of colorectal cancer according to stage at diagnosis in the Calvados Departement, France. Eur. J. Health Econ. 4, 102–106 (2003)CrossRefGoogle Scholar
  4. 4.
    Bouvier, A.M., Remontet, L., Jougla, E., Launoy, G., Grosclaude, P., Buemi, A., Tretarre, B., Velten, M., Dancourt, V., Menegoz, F., Guizard, A.V., Mace Lesec’h, J., Peng, J., Bercelli, P., Arveux, P., Esteve, J., Faivre, J.: Incidence des cancers digestifs en France. Gastroenterol. Clin. Biol. 28, 877–881 (2004)Google Scholar
  5. 5.
    Boyle, P., Ferlay, J.: Cancer incidence and mortality in Europe, 2004. Ann. Oncol. 16, 481–488 (2005)CrossRefGoogle Scholar
  6. 6.
    Brown, M.L., Riley, G.F., Potosky, A.L., Etzioni, R.D.: Obtaining long-term disease specific costs of care: application to Medicare enrollees diagnosed with colorectal cancer. Med. Care 37, 1249–1259 (1999)CrossRefGoogle Scholar
  7. 7.
    Charlson, M.E., Pompei, P., Ales, K.L., MacKenzie, C.R.: A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J. Chronic. Dis. 40, 373–383 (1987)CrossRefGoogle Scholar
  8. 8.
    CNAMTS (2001) Dossier étude et statistiques. Répartition géographique par département et par circonscription de caisse primaire au 31 décembre 2000, vol. 53. CNAMTS, ParisGoogle Scholar
  9. 9.
    Corn-Ruelle, L., Lucas-Gabrieli, V., Renaud, T.: Le coût du cancer du côlon en Ile-de-France. In: Bulletin d’information en économie de la santé. IRDES, Paris (2005)Google Scholar
  10. 10.
    Delco, F., Egger, R., Bauerfeind, P., Beglinger, C.: Hospital health care resource utilization and costs of colorectal cancer during the first 3-year period following diagnosis in Switzerland. Aliment. Pharmacol. Ther. 21, 615–622 (2005)CrossRefGoogle Scholar
  11. 11.
    Faivre, J., Dancourt, V., Lejeune, C., Tazi, M.A., Lamour, J., Gerard, D., Dassonville, F., Bonithon-Kopp, C.: Reduction in colorectal cancer mortality by fecal occult blood screening in a French controlled study. Gastroenterology 126, 1674–1680 (2004)CrossRefGoogle Scholar
  12. 12.
    Fireman, B.H., Quesenberry, C.P., Somkin, C.P., Jacobson, A.S., Baer, D., West, D., Potosky, A.L., Brown, M.L.: Cost of care for cancer in a health maintenance organization. Health Care Financ. Rev. 18, 51–76 (1997)Google Scholar
  13. 13.
    ICD-10 (ed.) International classification of disease for oncology. 10th revision. World Health Organization, Geneva (1990)Google Scholar
  14. 14.
    Kerrigan, M., Howlader, N., Mandelson, M.T., Harrison, R., Mansley, E.C., Ramsey, S.D.: Costs and survival of patients with colorectal cancer in a health maintenance organization and a preferred provider organization. Med. Care 43, 1043–1048 (2005)CrossRefGoogle Scholar
  15. 15.
    Manfredi, S., Bouvier, A.M., 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)CrossRefGoogle Scholar
  16. 16.
    Maroun, J., Ng, E., Berthelot, J.M., Le Petit, C., Dahrouge, S., Flanagan, W.M., Walker, H., Evans, W.K.: Lifetime costs of colon and rectal cancer management in Canada. Chronic Dis. Can. 24, 91–101 (2003)Google Scholar
  17. 17.
    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)CrossRefGoogle Scholar
  18. 18.
    Remontet, L., Estève, J., Bouvier, A.M., Grosclaude, P., Launoy, G., Ménégoz, F., Exbrayat, C., Tretare, B., Carli, P.M., Guizard, A., Troussard, X., Bercelli, P., Colonna, M., Halna, J., Hedelin, G., Mace-Lesec’h, J., Peng, J., Buémi, A., Velten, M., Jougla, E., Arveux, P., Le Bodic, L., Michel, E., Sauvage, M., Schvartz, C., Faivre, J.: Cancer incidence and mortality in France over the period 1978–2000. Rev. Epidemiol. Sante Publ. 51, 3–30 (2003)Google Scholar
  19. 19.
    Ross, P., Heron, J., Cunningham, D.: Cost of treating advanced colorectal cancer: a retrospective comparison of treatment regimens. Eur. J. Cancer 32 (A Suppl 5), S13–S17 (1996)CrossRefGoogle Scholar
  20. 20.
    Sant, M., Aareleid, T., Berrino, F., Bielska Lasota, M., Carli, P.M., Faivre, J., Grosclaude, P., Hedelin, G., Matsuda, T., Moller, H., Moller, T., Verdecchia, A., Capocaccia, R., Gatta, G., Micheli, A., Santaquilani, M., Roazzi, P., Lisi, D.: EUROCARE-3: survival of cancer patients diagnosed 1990–94–results and commentary. Ann. Oncol. 14 (Suppl 5), v61–v118 (2003)CrossRefGoogle Scholar
  21. 21.
    Schraub, S., Arveux, P., Mercier, M., Gauthier, M.: Recours aux soins chirurgicaux et coût des cancers: deux études utilisant les données de population. Rev. Epidemiol. Sante Publ. 44(Suppl 1), S33–S39 (1996)Google Scholar
  22. 22.
    Selke, B., Durand, I., Marissal, J.P., Chevalier, D., Lebrun, T.: Coût du cancer colorectal en France en 1999. Gastroenterol. Clin. Biol. 27, 22–27 (2003)Google Scholar
  23. 23.
    Sobin, L., Wittekind, C.: TNM Classification of Malignant Tumors. Union Internationale Contre le Cancer and the American Joint Committee on Cancer, fifth edition. New York (1997)Google Scholar
  24. 24.
    Taplin, S.H., Barlow, W., Urban, N., Mandelson, M.T., Timlin, D.J., Ichikawa, L., Nefcy, P.: Stage, age, comorbidity, and direct costs of colon, prostate, and breast cancer care. J. Natl. Cancer Inst. 87, 417–426 (1995)CrossRefGoogle Scholar
  25. 25.
    Thompson, S.G., Barber, J.A.: How should cost data in pragmatic randomised trials be analysed? BMJ 320, 1197–1200 (2000)CrossRefGoogle Scholar
  26. 26.
    Vernet, C., Lepage, C., Lejeune, C., Faivre, J., Bouvier, A.: Who is implicated in the care of digestive cancers? A population-based study over a 25-year period. Gastroenterol. Clin. Biol. 30, 1251–1255 (2006)CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Laurence Clerc
    • 1
    • 2
    • 5
  • Valérie Jooste
    • 1
    • 5
  • Catherine Lejeune
    • 1
    • 5
  • Bernard Schmitt
    • 2
  • Patrick Arveux
    • 3
  • Catherine Quantin
    • 1
    • 5
  • Jean Faivre
    • 1
    • 5
  • Anne-Marie Bouvier
    • 1
    • 4
    • 5
    Email author
  1. 1.Registre Bourguignon des Cancers Digestifs [INSERM U866], Faculté de MédecineDijon CedexFrance
  2. 2.CNAMTS DRSM Bourgogne Franche ComtéDijonFrance
  3. 3.Département d’Information MédicaleCentre Georges François LeclercDijonFrance
  4. 4.Centre Hospitalier Universitaire de DijonDijon CedexFrance
  5. 5.Université de BourgogneDijonFrance

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