This cost-effectiveness study analyses the expected impacts of activities proposed by the Croatian National Plan Against Cancer (NPAC) on cancer incidence and survival rates, as related to their respective costs. We evaluated the impact of the NPAC on two main outcomes, namely, reduced incidence and the improved survival of cancer patients, expressed as life years gained (LYGs), which enabled the calculation of incremental cost-effectiveness ratios (ICERs) in the form of cost per LYG. In the analysis of costs, we considered both the direct costs of NPAC activities as well as the wider indirect societal costs of cancer, thus permitting the calculation of the ICER both from the narrower national health insurer’s perspective (accounting only for the direct costs) and the wider societal perspective (accounting both for the direct and indirect costs). We estimated that on average, for all patients benefiting from the implementation of the NPAC in Croatia, an additional LYG would be yielded at the additional cost of €1.021 (societal perspective). The NPAC can, for some sites, even be considered a dominant intervention due to the negative cost/LYG ratio, meaning that it generates additional LYGs while at the same time, reducing total societal costs. Taking a narrower health insurer’s perspective (i.e., accounting only for the direct costs), the NPAC produces an additional LYG at an additional cost of €1.408. Both cost per LYG estimates can be considered cost-effective investment options.
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Period over which the NPAC is to be implemented.
Vrdoljak et. al.: National cancer control plan 2020–2030. https://www.nppr.hr/wp-content/uploads/2020/01/NPPR_ENG_final.pdf (2019). Accessed 20 Nov 2020
Eurostat. Assumptions for life expectancy by age, sex and type of projection. Available at https://appsso.eurostat.ec.europa.eu/nui/submitViewTableAction.do (2019). Accessed 16 Oct 2019
The European Partnership for Action Against Cancer (EPAAC). National Cancer Plan Collection. http://www.epaac.eu/national-cancer-plans 2020. Accessed Oct 2020
Romero, Y., Trapani, D., Johnson, S., Tittenbrun, Z., Given, L., Hohman, K., Stevens, L., Torode, J.S., Boniol, M., Ilbawi, A.M.: National cancer control plans: a global analysis. Lancet Oncol 19(10), e546–e555 (2018)
Ralaidovy, A.H., Gopalappa, C., Ilbawi, A., et al.: Cost-effective interventions for breast cancer, cervical cancer, and colorectal cancer: new results from WHO-CHOICE. Cost Eff Resour Alloc 16, 38 (2018)
Croatian Institute of Public Health. Croatian National Cancer Register. Cancer incidence in Croatia in 2016. Bulletin 41, Zagreb. https://www.hzjz.hr/wp-content/uploads/2017/01/Bilten-2016_zavrsna.pdf (2019). Accessed Nov 2019
Croatian Institute of Public Health. Demographic trends in Croatia in 2017. Zagreb. https://www.hzjz.hr/wp-content/uploads/2018/08/Prirodno_kretanje_2017.pdf (2018). Accessed Oct 2019
Eurostat. Cancer statistics. https://ec.europa.eu/eurostat/statistics-explained/index.php/Cancer_statistics#Deaths_from_cancer (2015). Accessed Nov 2019
Luengo-Fernandez, R., Leal, J., Gray, A., Sullivan, R.: Economic burden of cancer across the European Union: a population-based cost analysis. Lancet Oncol 14, 1165–1174 (2013)
Globocan. http://gco.iarc.fr/today/data/factsheets/populations/705-slovenia-fact-sheets.pdf (2018). Accessed May 2019
Croatian bureau of statistics (CBS, 2019). https://www.dzs.hr/Hrv_Eng/publication/2019/09-01-01_05_2019.htm (2019). Accessed May 2019
Cancer Registry of Republic of Slovenia. https://www.onko-i.si/fileadmin/onko/datoteke/dokumenti/LP_2006.pdf (2006). Accessed May 2019
Bray, F., Ferlay, J., Soerjomataram, I., Siegel, R.L., Torre, L.A., Jemal, A.: Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68(6), 394–424 (2018)
Vrdoljak, E., Bodoky, G., Jassem, J., Popescu, R., Pirker, R., Čufer, T., Bešlija, S., Eniu, A., Todorović, V., Kopečková, K., Kurteva, G.: Expenditures on oncology drugs and cancer mortality-to-incidence ratio in central and Eastern Europe. Oncologist 24(1), e30–e37 (2019)
Vrdoljak, E., Bodoky, G., Jassem, J., Popescu, R.A., Mardiak, J., Pirker, R., Cufer, T., Bešlija, S., Eniu, A., Todorović, V., KubáčkováKurteva, K.G., Tomašević, Z., Sallaku, A., Smichkoska, S., Bajić, Z., Sikić, B.I.: Cancer control in central and eastern Europe: current situation and recommendations for improvement. Oncologist 21(10), 1183–1190 (2016)
American Cancer Society. Cancer facts and figures. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2019/cancer-facts-and-figures-2019.pdf (2019). Accessed Nov 2019
Office for National Statistics. https://www.nuffieldtrust.org.uk/resource/cancer-survival-rates (2019). Accessed Nov 2019
OECD. https://stats.oecd.org/Index.aspx?QueryId=51882 (2019). Accessed Nov 2019
Leal, J., Wordsworth, S., Legood, R., Blair, E.: Eliciting expert opinion for economic models: an applied example. Value Health 10(3), 195–203 (2007)
Zadnik, V., Zakelj, M.P., Lokar, K., Jarm, K., Ivanus, U., Zagar, T.: Cancer burden in Slovenia with the time trends analysis. Radiol Oncol 51(1), 47–55 (2017)
Gold, M.R., Siegel, J.E., Russell, L.B., Weinstein, M.C.: Cost-effectiveness in health and medicine. Oxford University Press, New York (1996)
Drummond, M.F., Sculpher, M.J., Torrance, G.W., O’Brien, B.J., Stoddart, G.L.: Methods for the economic evaluation of health care programmes, 3rd edn. Oxford University Press, Oxford (2005)
We gratefully thank the current and former ministers of health of the Republic of Croatia, Dr Milan Kujundzic, PhD and Dr Vili Beros, PhD for their continued support and political leadership in the development of the National Plan Against Cancer. The work of Ana Bobinac was supported in part by the Croatian science fundation (UIP-2019-04-3721).
The work of Ana Bobinac was supported in part by the Croatian science fundation (UIP-2019-04-3721).
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Vrdoljak, E., Sekerija, M., Plestina, S. et al. Is it too expensive to fight cancer? Analysis of incremental costs and benefits of the Croatian National Plan Against Cancer. Eur J Health Econ 22, 393–403 (2021). https://doi.org/10.1007/s10198-020-01262-0
- Economic evaluation
- National plan against cancer
- Cost per LYG
- I18 Government Policy
- Public Health