, Volume 31, Issue 7, pp 577–588 | Cite as

Cost of Illness in Colorectal Cancer: An International Review

  • Christine KrizaEmail author
  • Martin Emmert
  • Philip Wahlster
  • Charlotte Niederländer
  • Peter Kolominsky-Rabas
Systematic Review



Given the current—and increasing—pressure to limit expenditure on health care provision in many countries, a better understanding of the cost burden of colorectal cancer is needed. Cost-of-illness studies and reviews thereof can be a useful tool for analysing and critically evaluating the cost-related development of colorectal cancer, and they highlight important cost drivers.


A systematic review was conducted from 2002 to 2012 to identify cost-of-illness studies related to colorectal cancer, searching the Medline, PubMed, Science Direct, Cochrane Library and the York CRD databases.


Among the 10 studies (from France, the US, Ireland and Taiwan) included in the review, 6 studies reported prevalence-based estimates and 4 studies focussed on incidence-based data. In the studies included in the review, long-term costs for colorectal cancer of up to $50,175 per patient (2008 values) were estimated. Most of the studies in the review showed that the initial and terminal phases of colorectal cancer care are the most expensive, with continuing treatment being the least costly phase. One study also highlighted that stage I CRC disease was the least costly and stage III the most costly of all 4 stages, due to the high cost impact of biological agents.


This review has highlighted a trend for rising costs associated with CRC, which is linked to the increasing use of targeted biological therapies. COI studies in colorectal cancer can identify specific components and areas of care that are especially costly, thereby focussing attention on more cost-effective approaches, which is especially relevant to the increased use of biological agents in the field of personalised medicine. COI studies are an important tool for further health economic evaluations of personalised medicine.


Cost Aspect Hospital Inpatient Care Important Cost Driver Patient Time Cost Colorectal Cancer Care 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Role of the Funding Source

This research is supported by the German Federal Ministry of Education and Research (BMBF), project grant no. 01EX1013B, as part of the Centre of Excellence for Medical Technology.


  1. 1.
    Karsa LV, Lignini TA, Patnick J, Lambert R, Sauvaget C. The dimensions of the CRC problem. Best Pract Res Clin Gastroenterol. 2010;24(4):381–96.PubMedCrossRefGoogle Scholar
  2. 2.
    Center MM, Jemal A, Smith RA, Ward E. Worldwide variations in colorectal cancer. CA Cancer J Clin. 2009;59(6):366–78.PubMedCrossRefGoogle Scholar
  3. 3.
    Gellad ZF, Provenzale D. Colorectal cancer: national and international perspective on the burden of disease and public health impact. Gastroenterology. 2010;138(6):2177–90.PubMedCrossRefGoogle Scholar
  4. 4.
    Yabroff KR, Warren JL, Banthin J, Schrag D, Mariotto A, Lawrence W, et al. Comparison of approaches for estimating prevalence costs of care for cancer patients: what is the impact of data source? Med Care. 2009;47(7 Suppl 1):S64–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Larg A, Moss JR. Cost-of-illness studies: a guide to critical evaluation. PharmacoEconomics. 2011;29(8):653–71.PubMedCrossRefGoogle Scholar
  6. 6.
    Akobundu E, Ju J, Blatt L, Mullins CD. Cost-of-illness studies: a review of current methods. PharmacoEconomics. 2006;24(9):869–90.PubMedCrossRefGoogle Scholar
  7. 7.
    Damm O, Hodek JM, Greiner W. Methodological standards for cost-of-illness studies using breast cancer, prostate cancer and colon cancer as an example. Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen. 2009;103(6):305–16. Methodische Standards von Krankheitskostenstudien am Beispiel von Brust-, Prostata- und Darmkrebs.Google Scholar
  8. 8.
    Segel J. Cost-of-illness studies—a primer. Research Triangle Park: RTI International; 2006. Updated 24/03/2012.
  9. 9.
    Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6(7):e1000100.PubMedCrossRefGoogle Scholar
  10. 10.
    Tappenden P, Chilcott J, Brennan A, Pilgrim H. Systematic review of economic evidence for the detection, diagnosis, treatment, and follow-up of colorectal cancer in the United Kingdom. Int J Technol Assess Health Care. 2009;25(4):470–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Evers S, Goossens M, de Vet H, van Tulder M, Ament A. Criteria list for assessment of methodological quality of economic evaluations: consensus on health economic criteria. Int J Technol Assess Health Care. 2005;21(2):240–5.PubMedGoogle Scholar
  12. 12.
    Drummond MF, Jefferson TO. Guidelines for authors and peer reviewers of economic submissions to the BMJ. BMJ. 1996;313(7052):275–83.PubMedCrossRefGoogle Scholar
  13. 13.
    Bouvier V, Reaud JM, Gignoux M, Launoy G. Cost of diagnostic and therapeutic management of colorectal cancer according to stage at diagnosis in the Calvados Department, France. Eur J Health Econ. 2003;4(2):102–6.PubMedCrossRefGoogle Scholar
  14. 14.
    Selke B, Durand I, Marissal JP, Chevalier D, Lebrun T. Cost of colorectal cancer in France in 1999. Gastroen Clin Biol. 2003;27(1):22–7.Google Scholar
  15. 15.
    Chang S, Long SR, Kutikova L, Bowman L, Finley D, Crown WH, et al. Estimating the cost of cancer: results on the basis of claims data analyses for cancer patients diagnosed with seven types of cancer during 1999 to 2000. J Clin Oncol. 2004;22(17):3524–30.PubMedCrossRefGoogle Scholar
  16. 16.
    Paramore LC, Thomas SK, Knopf KB, Cragin LS, Fraeman KH. Estimating costs of care for patients with newly diagnosed metastatic colorectal cancer. Clin Colorectal Cancer. 2006;6(1):52–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Clerc L, Jooste V, Lejeune C, Schmitt B, Arveux P, Quantin C, et al. Cost of care of colorectal cancers according to health care patterns and stage at diagnosis in France. Eur J Health Econ. 2008;9(4):361–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Song X, Zhao Z, Barber B, Gregory C, Cao Z, Gao S. Cost of illness in patients with metastatic colorectal cancer. J Med Econ. 2011;14(1):1–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Ramsey SD, Berry K, Etzioni R. Lifetime cancer-attributable cost of care for long term survivors of colorectal cancer. Am J Gastroenterol. 2002;97(2):440–5.PubMedCrossRefGoogle Scholar
  20. 20.
    Lang K, Lines LM, Lee DW, Korn JR, Earle CC, Menzin J. Lifetime and treatment-phase costs associated with colorectal cancer: evidence from SEER-Medicare data. Clin Gastroenterol Hepatol. 2009;7(2):198–204.PubMedCrossRefGoogle Scholar
  21. 21.
    Lang HC, Wu SL. Lifetime costs of the top five cancers in Taiwan. Eur J Health Econ. 2012;13:347–53.PubMedCrossRefGoogle Scholar
  22. 22.
    Tilson L, Sharp L, Usher C, Walsh C, O’Ceilleachair A, et al. Cost of care for colorectal cancer in Ireland: a health care payer perspective. Eur J Health Econ. 2012;13:511–24.PubMedCrossRefGoogle Scholar
  23. 23.
    Payne KA, Huybrechts KF, Caro J, Craig Green TJ, Klittich WS. Long term cost-of-illness in stroke: an international review. PharmacoEconomics. 2002;20(12):813–25.PubMedCrossRefGoogle Scholar
  24. 24.
    Kwon SJ. Evaluation of the 7th UICC TNM staging system of gastric cancer. J Gastric Cancer. 2011;11(2):78–85.PubMedCrossRefGoogle Scholar
  25. 25.
    Sullivan R, Peppercorn J, Sikora K, Zalcberg J, Meropol NJ, Amir E, et al. Delivering affordable cancer care in high-income countries. Lancet Oncol. 2011;12(10):933–80.PubMedCrossRefGoogle Scholar
  26. 26.
    Mariotto AB, Yabroff KR, Shao Y, Feuer EJ, Brown ML. Projections of the cost of cancer care in the United States: 2010–2020. J Natl Cancer Inst. 2011;103(2):117–28.PubMedCrossRefGoogle Scholar
  27. 27.
    Wong YN, Meropol NJ, Speier W, Sargent D, Goldberg RM, Beck JR. Cost implications of new treatments for advanced colorectal cancer. Cancer. 2009;115(10):2081–91.PubMedCrossRefGoogle Scholar
  28. 28.
    Verma M. Personalized medicine and cancer. J Pers Med. 2012;2(1):1–14.CrossRefGoogle Scholar
  29. 29.
    Shiroiwa T, Motoo Y, Tsutani K. Cost-effectiveness analysis of KRAS testing and cetuximab as last-line therapy for colorectal cancer. Mol Diagn Therapy. 2010;14(6):375–84.CrossRefGoogle Scholar
  30. 30.
    Wong WB, Carlson JJ, Thariani R, Veenstra DL. Cost effectiveness of pharmacogenomics: a critical and systematic review. PharmacoEconomics. 2010;28(11):1001–13.PubMedCrossRefGoogle Scholar
  31. 31.
    Yabroff KR, Warren JL, Knopf K, Davis WW, Brown ML. Estimating patient time costs associated with colorectal cancer care. Med Care. 2005;43(7):640–8.PubMedCrossRefGoogle Scholar
  32. 32.
    Van Houtven CH, Ramsey SD, Hornbrook MC, Atienza AA, van Ryn M. Economic burden for informal caregivers of lung and colorectal cancer patients. Oncologist. 2010;15(8):883–93.PubMedCrossRefGoogle Scholar
  33. 33.
    Syse A, Tretli S, Kravdal O. The impact of cancer on spouses’ labor earnings: a population-based study. Cancer. 2009;115(18 Suppl):4350–61.PubMedCrossRefGoogle Scholar
  34. 34.
    Cotrim H, Pereira G. Impact of colorectal cancer on patient and family: implications for care. Eur J Oncol Nurs. 2008;12(3):217–26.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2013

Authors and Affiliations

  • Christine Kriza
    • 1
    Email author
  • Martin Emmert
    • 2
  • Philip Wahlster
    • 1
  • Charlotte Niederländer
    • 1
  • Peter Kolominsky-Rabas
    • 1
  1. 1.Interdisciplinary Centre for Health Technology Assessment and Public HealthUniversity of Erlangen-Nuremberg, National BMBF-Cluster of Excellence “Medical Technologies-Medical Valley EMN”ErlangenGermany
  2. 2.School of Business and Economics, Institute of ManagementUniversity of Erlangen-NurembergNurembergGermany

Personalised recommendations