Cost of care for colorectal cancer in Ireland: a health care payer perspective
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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.
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.
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.
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.
KeywordsColorectal cancer Cost Health care resources Chemotherapy
JEL ClassificationI10 I11
We are grateful to the Expert Advisory Group, HTA Directorate and Board of the Health Information and Quality Authority for their input into this study. The views expressed are not necessarily those of the Health Information and Quality Authority. We are particularly grateful to those individuals who provided data. We would also like to thank numerous individuals for helpful discussions and input; these individuals are listed in the full HTA report (available at: www.hiqa.ie) . This study was funded by the Health Information and Quality Authority and the Health Research Board. The authors have no conflicts of interest to declare.
- 7.Jonnson, B., Wilking, N.: A global comparison regarding patient access to cancer drugs. Ann. Oncol. 18(Suppl 3), 1–77 (2007)Google Scholar
- 11.International Agency for Research on Cancer. Colorectal cancer incidence and mortality worldwide in 2008 (http://globocan.iarc.fr/factsheets/cancers/colorectal.asp), 2008. Accessed Jan 2011
- 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
- 18.Scottish Intercollegiate Guidelines Network (SIGN). Management of colorectal cancer. A national clinical guideline. No.67 (http://www.sign.ac.uk/guidelines/fulltext/67/index.html), 2003. Accessed March 2010
- 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)Google Scholar
- 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
- 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.National Comprehensive Cancer Network. Rectal cancer clinical practice guidelines in oncology (Version 1)(2006b) (http://www.nccn.org), Accessed April 2010
- 27.National Comprehensive Cancer Network. Colon cancer Clinical Practice Guidelines in Oncology (Version 1)(2006a) (http://www.nccn.org), Accessed March 2010
- 28.Association of Coloproctology of Great Britain and Ireland: Guidelines for the management of colorectal cancer. 3rd Edn. (2007) (http://www.acpgbi.org.uk), Accessed April 2010
- 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)Google Scholar
- 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)Google Scholar
- 41.Health Information and Quality Authority. Draft guidelines for the economic evaluation of health technologies in Ireland (http://www.hiqa.ie/media/pdfs/Draft_economic_guidelines_consultation_0710.pdf), 2010. Accessed August 2010
- 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)Google Scholar
- 45.Monthly Index of Medical Specialities (MIMS): Ireland. (August 2008)Google Scholar
- 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
- 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]Google Scholar