Skip to main content
SpringerLink
Log in

Cost of Illness in Colorectal Cancer: An International Review

  • Systematic Review
  • Published:
PharmacoEconomics Aims and scope Submit manuscript

Abstract

Objectives

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.

Methods

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.

Results

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.

Conclusions

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Notes

  1. KRAS: V-Ki-ras2 Kirsten rat sarcoma viral oncogene homolog.

  2. UGT1A: uridine diphosphate glucuronyltransferase.

References

  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.

    Article  PubMed  CAS  Google Scholar 

  2. Center MM, Jemal A, Smith RA, Ward E. Worldwide variations in colorectal cancer. CA Cancer J Clin. 2009;59(6):366–78.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  5. Larg A, Moss JR. Cost-of-illness studies: a guide to critical evaluation. PharmacoEconomics. 2011;29(8):653–71.

    Article  PubMed  Google Scholar 

  6. Akobundu E, Ju J, Blatt L, Mullins CD. Cost-of-illness studies: a review of current methods. PharmacoEconomics. 2006;24(9):869–90.

    Article  PubMed  Google Scholar 

  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.

  8. Segel J. Cost-of-illness studies—a primer. Research Triangle Park: RTI International; 2006. http://www.rti.org/pubs/coi_primer.pdf. Updated 24/03/2012.

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  12. Drummond MF, Jefferson TO. Guidelines for authors and peer reviewers of economic submissions to the BMJ. BMJ. 1996;313(7052):275–83.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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. 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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  21. Lang HC, Wu SL. Lifetime costs of the top five cancers in Taiwan. Eur J Health Econ. 2012;13:347–53.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  24. Kwon SJ. Evaluation of the 7th UICC TNM staging system of gastric cancer. J Gastric Cancer. 2011;11(2):78–85.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  28. Verma M. Personalized medicine and cancer. J Pers Med. 2012;2(1):1–14.

    Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  30. Wong WB, Carlson JJ, Thariani R, Veenstra DL. Cost effectiveness of pharmacogenomics: a critical and systematic review. PharmacoEconomics. 2010;28(11):1001–13.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

Download references

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.

Author information

Authors and Affiliations

  1. Interdisciplinary Centre for Health Technology Assessment and Public Health, University of Erlangen-Nuremberg, National BMBF-Cluster of Excellence “Medical Technologies-Medical Valley EMN”, Schwabachanlage 6, 91054, Erlangen, Germany

    Christine Kriza, Philip Wahlster, Charlotte Niederländer & Peter Kolominsky-Rabas

  2. School of Business and Economics, Institute of Management, University of Erlangen-Nuremberg, Lange Gasse 20, 90403, Nuremberg, Germany

    Martin Emmert

Authors
  1. Christine Kriza
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Martin Emmert
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Philip Wahlster
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Charlotte Niederländer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Peter Kolominsky-Rabas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christine Kriza.

Appendix

Appendix

The following criteria were used for study inclusion.

Study methods are described in adequate detail:

  • The study population is clearly described

  • There is a well-defined research question, posed in an answerable form

  • The disease differentiation is clearly laid out for colorectal cancer

  • The viewpoints of the analysis are clearly stated

There is enough economic detail in the study:

  • All costs are measured appropriately, i.e. monetary values for disease-specific attributed costs

  • The chosen time horizon is appropriate for the inclusion of relevant costs and consequences

  • Estimates of indirect and direct aspects of costs for colorectal cancer are given

  • The differentiation of cost aspects is made appropriately and in physical units

  • The different cost components are described in sufficient detail

  • For long-term costs of colorectal cancer, the estimates are based on a period of a minimum of 5 years of care following the onset of disease

The following exclusion criteria were used:

  • Cost-of-illness studies referring to colon cancer alone (excluding rectal cancer)

  • Studies focusing on co-morbidities like diarrhoea-related diseases as a result of chemotherapy

  • Studies referring to costs of colorectal screening interventions only

  • Studies comparing cost-effectiveness among different treatments for colorectal cancer

  • Cost-of-illness studies focusing on just one disease stage of colorectal cancer

  • Reviews of existing economic studies relating to colorectal cancer

  • Studies not reported in English or German

Search term

Database

Medline

PubMed

CRD York (incl. NHS EED)

Cochrane

Science Direct

“Cost” AND “colorectal cancer”

1,521 results on 12/03/2012

None relevant, or they were duplicates

1,637 results on 23/02/2012

None relevant, or they were duplicates

337 results on 12/03/2012

None relevant

164 results on 08/03/2012

None relevant

407 results on 17/03/2012 (abstract, title, keywords)

None relevant, or they were duplicates

“Cost” AND “colon cancer”

326 results on 12/03/2012

None relevant, or they were duplicates

358 results on 23/02/2012.

Of these, 2 papers was deemed relevant on 08/03/2012

77 results on 12/03/2012

None relevant

3 results on 08/03/2012

117 results on 17/03/2012 (abstract, title, keywords)

None relevant, or they were duplicates

“Cost of illness” AND “colorectal cancer”

57 results on 12/03/2012

PubMed result duplicates

57 results on 23/02/2012

Of these, 23 papers were deemed relevant on 08/03/2012

8 results on 12/03/2012

None relevant

2 results on 08/03/2012

None relevant

150 results on 12/03/2012

3 relevant

“Cost of illness” AND “colon cancer”

18 results on 12/03/2012

PubMed result duplicates

18 results on 23/02/2012

None relevant, or they were duplicates

3 results on 12/03/2012

None relevant

1 result on 08/03/2012

Not relevant

83 results on 12/03/2012

None relevant

“Economics” AND “colorectal cancer”

40 results on 12/03/2012

Of these, 1 paper was deemed relevant on 12.03.2012

1,141 results on 28/02/2012

Of these, 1 paper was deemed relevant on 08/03/2012

234 results on 12/03/2012

None relevant

21 results on 08/03/2012

None relevant

15 results on 17/03/2012 (abstract, title, keywords)

None relevant

“Economics” AND “colon cancer”

8 results on 12/03/2012

None relevant, or they were duplicates

235 results 28/02/2012

Of these, 1 paper was deemed relevant on 08/03/2012

55 results on 12/03/2012

None relevant

1 result on 08/03/2012

Not relevant

5 results on 17/03/2012 (abstract, title, keywords)

None relevant

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kriza, C., Emmert, M., Wahlster, P. et al. Cost of Illness in Colorectal Cancer: An International Review. PharmacoEconomics 31, 577–588 (2013). https://doi.org/10.1007/s40273-013-0055-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40273-013-0055-4

Keywords

Search

Navigation