, Volume 25, Issue 7, pp 537–562 | Cite as

Cost Considerations in the Treatment of Colorectal Cancer

  • Frank G. A. JansmanEmail author
  • Maarten J. Postma
  • Jacobus R. B. J. Brouwers
Review Article


Colorectal cancer is among the most common malignancies in developed countries. Screening can reduce mortality significantly, although the most appropriate method is still under debate. Observational studies have revealed that lifestyle measures may also be beneficial for prevention of colorectal cancer.

Surgery is still the most effective treatment modality for colorectal cancer. The survival benefits of chemotherapy are only modest. For nearly 5 decades, 5-fluorouracil (5-FU) has been the main cytotoxic agent for treatment of colorectal cancer. In the last decade, the new cytotoxic agents raltitrexed, irinotecan and oxaliplatin have been introduced, next to the oral 5-FU analogues capecitabine and tegafur in combination with uracil (UFT). Moreover, the immunotherapeutics bevacizumab and cetuximab have become approved for treatment of metastatic colorectal cancer.

The economic implications of colorectal cancer treatment are substantial. The costs of treatment are mainly attributable to the early and terminal stage of the disease (i.e. surgery, hospitalisation, chemo- and immunotherapy and supportive care). The introduction of new chemo- and immunotherapeutics has caused a continuing increase of treatment expenditures. Therefore, comparative costs and cost effectiveness are important for assessing the value of new treatment regimens.

The available study results suggest that addition of irinotecan or oxaliplatin to 5-FU/folinic acid dosage regimens is cost effective. Also, capecitabine is calculated to be cost effective when compared with 5-FU/folinic acid. For UFT, no comparative studies of cost effectiveness were found. Since raltitrexed and 5-FU/folinic acid have shown equal efficacy in terms of survival, cost-effectiveness analysis is considered not to be applicable and cost-minimisation analysis may be sufficient. At present, pharmacoeconomic analyses of combination treatment with the immunotherapeutics bevacizumab or cetuximab are not available, except for recent cost-effectiveness considerations by the UK National Institute for Health and Clinical Excellence with negative recommendations for both agents in the treatment of metastatic colorectal cancer.

Given the high treatment costs, substantial toxicity and relatively limited efficacy of the fast changing chemo- and immunotherapeutic combinations for colorectal cancer, examination of cost-effectiveness studies should be conducted on a routine basis along with determination of clinical benefits.


Colorectal Cancer Bevacizumab Irinotecan Oxaliplatin Capecitabine 
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.



No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.


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Copyright information

© Adis Data Information BV 2007

Authors and Affiliations

  • Frank G. A. Jansman
    • 1
    • 2
    Email author
  • Maarten J. Postma
    • 3
  • Jacobus R. B. J. Brouwers
    • 1
  1. 1.Groningen University Institute for Drug Exploration (GUIDE), Department of Pharmacotherapy & Pharmaceutical CareUniversity of GroningenGroningenThe Netherlands
  2. 2.Department of Clinical PharmacyIsala KliniekenZwolleThe Netherlands
  3. 3.Groningen University Institute for Drug Exploration (GUIDE), Department of Social Pharmacy & PharmacoepidemiologyUniversity of GroningenGroningenThe Netherlands

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