Screening, prevention and socioeconomic costs associated with the treatment of colorectal cancer

Abstract

Colorectal cancer (CRC), the third most prevalent cancer worldwide, imposes a significant economic and humanistic burden on patients and society. One study conservatively estimated the annual expenditures for colorectal cancer to be approximately $US5.3 billion in 2000, including both direct and indirect costs. However, other investigators estimated inpatient costs alone incurred in the US in 1994 to be around $US5.14 billion. Therefore, the economic burden of colorectal cancer in the US could be projected to be somewhere in the range of $US5.5–6.5 billion by considering that inpatient costs approximate 80% of total direct costs. No worldwide data have been published, but assuming that the US represents 25–40% of total expenditures in oncology, as seen for breast and lung cancers, a rough estimate for colorectal cancer would be in the range of $US14–22 billion.

Screening helps increase patient survival by diagnosing colorectal cancer early. The ideal method among the four tests most used (faecal occult blood test, flexible sigmoidoscopy, colonoscopy and double contrast barium enema) has not been identified. Economic studies of colorectal cancer screening are complex because of the many variables involved, as well as the fact that the outcomes must be followed for many years, and the lack of consensus on screening guidelines.

Intuitively, modelling colorectal cancer is one way to overcome these hurdles; published modelling studies predict colorectal cancer screening programs to be within the threshold of $US40 000 per life-year saved. The faecal occult blood test appears to be the only clearly effective test, both from a clinical and an economic viewpoint. Important limitations are the invasiveness and inconvenience of the screening procedures, except faecal occult blood test. Patients’ comfort and satisfaction are essential in improving compliance with screening recommendations, which appears to be low even in the US (35% of the general population aged over 40 years and 60% of the high-risk population), the country with the highest awareness and compliance in the world.

Since colorectal cancer is generally a disease of the elderly, its economic burden is expected to grow in the near future, mainly due to population aging. Potential avenues to pursue in order to contain or reduce the economic burden of colorectal cancer would be the design and implementation of efficient screening programmes, the improvement of patient awareness and compliance with screening guidelines, the development of appropriate prevention programs (i.e. primary and secondary), and earlier diagnosis.

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

Table I
Table II
Table III
Table IV
Table V
Table VI
Table VII

Notes

  1. 1.

    Use of tradenames is for product identification purposes only and does not imply endorsement.

References

  1. 1.

    Agency for Health Care Policy and Research. Colorectal cancer screening: technical review. Rockville (MD): Agency for Health Care Policy and Research; 1998. AHCPR Publication No. 98-0033, 1–154

    Google Scholar 

  2. 2.

    WHO. Global cancer rates could increase by 50% to 15 million by 2020. Available from URL: http://www.who.int/mediacen-tre/releases/2003/pr27/en/print.html [Accessed 2003 Aug 7]

  3. 3.

    The American Cancer Society (ACS). Cancer facts & figures, 2002, 41-43. Available from URL: http://www.cancer.org [Accessed 2003 Aug 7]

  4. 4.

    Singh PN, Fraser GE. Dietary risk factors for colon cancer in a low-risk population. Am J Epidemiol 1998; 148: 761–74

    PubMed  CAS  Article  Google Scholar 

  5. 5.

    Potter JD. Nutrition and colorectal cancer. Cancer Causes Control 1996; 7: 127–46

    PubMed  CAS  Article  Google Scholar 

  6. 6.

    Cohen AM, Minsky BD, Schilsky RL. Cancers of the gastrointestinal tract: cancer of the colon. In: De Vita VT, Hellman S, Rosenberg SA, editors. Cancer: principles and practice of oncology. Philadelphia: Lippincott-Raven, 1997: 1144–97

    Google Scholar 

  7. 7.

    Winawer SJ, Fletcher RH, Miller L, et al. Colorectal cancer screening: clinical guidelines and rationale. Gastroenterology 1997; 112: 594–642

    PubMed  CAS  Article  Google Scholar 

  8. 8.

    Byers T, Levin B, Rothenberger DA, et al. Am Cancer Society guidelines for screening and surveillance for early detection of colorectal polyps and cancer. CA Cancer J Clin 1997; 47: 15460

    Article  Google Scholar 

  9. 9.

    Ransohoff DF, Lang CA. Clinical guidelines: Part II. Screening for colorectal cancer with the fecal occult blood test: a back-ground paper. Ann Intern Med 1997; 126: 811–22

    PubMed  CAS  Google Scholar 

  10. 10.

    Hoff G, Sauar J, Hofstad B, et al. The Norwegian guidelines for surveillance after polypectomy: 10-year intervals. Scand J Gastroenterol 1996; 31: 834–6

    PubMed  CAS  Article  Google Scholar 

  11. 11.

    Madden MV. South African Gastroenterology Society guidelines for colonoscopy in premalignant conditions and after resection of large-bowel cancer. S Afr Med J 1992; 81: 369–70

    PubMed  CAS  Google Scholar 

  12. 12.

    Winawer SJ, St John DJ, Bond III, et al. Prevention of colorectal cancer: guidelines based on new data. WHO Collaborating Center for the Prevention of Colorectal Cancer. Bull World Health Organ 1995; 73: 7–10

    PubMed  CAS  Google Scholar 

  13. 13.

    Palitz AM, Selby JV, Grossman S, et al. The colon cancer prevention program (CoCaP): rationale, implementation, and preliminary results. HMO Pract 1997; 11: 5–12

    PubMed  CAS  Google Scholar 

  14. 14.

    Kaye JA, Shulman LN. Screening program for colorectal cancer: effect on stage distribution. HMO Pract 1992; 6: 13–5

    PubMed  CAS  Google Scholar 

  15. 15.

    Atkin WS. Flexible sigmoidoscopy as a mass screening tool. Fur J Gastroenterol Hepatol 1998; 10: 219–23

    CAS  Article  Google Scholar 

  16. 16.

    Leard LE, Savides TJ, Ganiats TG. Patient preferences for colorectal cancer screening. J Fam Pract 1997; 45: 211–8

    PubMed  CAS  Google Scholar 

  17. 17.

    Cromwell DM, Moore RD, Bresinger JD, et al. Cost analysis of alternative approaches to colorectal screening in familial adenomatous polyposis. Gastroenterology 1998; 114: 893–901

    PubMed  CAS  Article  Google Scholar 

  18. 18.

    Vernon SW. Adherence to colorectal cancer screening: a brief overview. Ann NY Acad Sci 1995; 768: 292–5

    PubMed  CAS  Article  Google Scholar 

  19. 19.

    DiPalma AM, Barnes SE, DiPalma JA. Patient participation in colon cancer screening programs. South Med J 1998; 91: 342–4

    PubMed  CAS  Article  Google Scholar 

  20. 20.

    Gob HS, Wong J. The Singapore polyposis registry. Ann Acad Med Singapore 1992; 21: 290–3

    Google Scholar 

  21. 21.

    The American Cancer Society 1996 Advisory Committee. Guidelines on diet, nutrition, and cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. Cancer J Clin 1996; 46: 325–41

    Article  Google Scholar 

  22. 22.

    Greenwald P, McDonald SS. Cancer prevention: the roles of diet and chemoprevention. Cancer Control 1997; 4: 118–27

    PubMed  Google Scholar 

  23. 23.

    Martinez ME, McPherson RS, Levin B, et al. A case-control study of dietary intake and other lifestyle risk factors for hyperplastic polyps. Gastroenterology 1997; 113: 423–9

    PubMed  CAS  Article  Google Scholar 

  24. 24.

    Platz EA, Giovannucci E, Rimm EB, et al. Dietary fiber and distal colorectal adenoma in men. Cancer Epidemiol Biomarkers Prev 1997; 6: 661–70

    PubMed  CAS  Google Scholar 

  25. 25.

    Fuchs CS, Giovannucci EL, Colditz GA, et al. Dietary fiber and the risk of colorectal cancer and adenoma in women. N Engl J Med 1999; 340: 169–76

    PubMed  CAS  Article  Google Scholar 

  26. 26.

    National Cancer Institute PDQ clinical trial abstracts [online]. Available from URL: http://www.nei.nih.gov/ [Accessed 2003 Sep 1]

  27. 27.

    Haile RW, Witte IS, Longnecker MP, et al. A sigmoidoscopy-based case-control study of polyps: macronutrients, fiber and meat consumption. Int J Cancer 1997; 73: 497–502

    PubMed  CAS  Article  Google Scholar 

  28. 28.

    Jacobs DR, Marquart L, Slavin J, et al. Whole grain intake and cancer: an expanded review and meta-analysis. Nutr Cancer 1998; 30: 85–96

    PubMed  Article  Google Scholar 

  29. 29.

    Slattery M, Edwards SL, Anderson K, et al. Vitamin E and colon cancer: is there an association? Nutr Cancer 1998; 30: 201–6

    PubMed  CAS  Article  Google Scholar 

  30. 30.

    Hofstad B, Almendingen K, Vain M, et al. Growth and recurrence of colorectal polyps: a double-blind 3-year intervention with calcium and antioxidants. Digestion 1998; 59: 148–56

    PubMed  CAS  Article  Google Scholar 

  31. 31.

    Advisory Committee on Cancer Coordination and Control. Prevention in the North Carolina Cancer control plan 1996–2001. USA: American Cancer Society, NC Department of Environment, Health, and Natural Resources; 1996: I-9-I-18

    Google Scholar 

  32. 32.

    Schatzkin A, Kelloff G. Chemo- and dietary prevention of colorectal cancer. Fur J Cancer 1995; 31A (7–8): 1198-204

    CAS  Google Scholar 

  33. 33.

    Greenberg ER, Baron JA, Tosteson TD, et al. A clinical trial of antioxidant vitamins to prevent colorectal adenoma. Polyp Prevention Study Group. N Engl J Med 1994; 331: 141–7

    PubMed  CAS  Article  Google Scholar 

  34. 34.

    Jacobson IS, Neugut AI, Murray T, et al. Cigarette smoking and other behavioral risk factors for recurrence of colorectal adenomatous polyps. Cancer Causes Control 1994; 5: 215–20

    PubMed  CAS  Article  Google Scholar 

  35. 35.

    Baron JA, Beach M, Mandel IS, et al. Calcium supplements for the prevention of colorectal adenomas. Calcium Polyp Prevention Study Group. N Engl J Med 1999; 340: 101–7

    PubMed  CAS  Article  Google Scholar 

  36. 36.

    Kelloff GJ, Hawk ET, Crowell JA, et al. Strategies for identification and clinical evaluation of promising chemopreventioe agents. Oncology 1996; 10: 1471–84

    PubMed  CAS  Google Scholar 

  37. 37.

    DuBois RN, Smalley WE. Cyclooxygenase, NSAIDs, and colo-rectal cancer. Gastroenterol 1996; 31: 898–906

    CAS  Article  Google Scholar 

  38. 38.

    Weiss HA, Forman D. Aspirin. NSAIDs and protection from colorectal cancer: a review of the epidemiological evidence. Scand J Gastroenterol Suppl. 1996; 220: 137–41

    PubMed  CAS  Article  Google Scholar 

  39. 39.

    Thun MI. Aspirin and gastrointestinal cancer. Adv Exp Med Biol 1997; 400A: 395–402

    PubMed  CAS  Article  Google Scholar 

  40. 40.

    Smalley WE, DuBois RN. Colorectal cancer and nonsteroidal anti-inflammatory drugs. Adv Pharmacol 1997; 39: 1–20

    PubMed  CAS  Article  Google Scholar 

  41. 41.

    Adis R&D Insight. Auckland: Adis International Ltd, 1999

  42. 42.

    IMSworld R&D Focus. London: IMS Global Services, 1998

  43. 43.

    Pharmaprojects database. Surrey: PJB Publications Ltd, 1997

  44. 44.

    Martinez ME, McPherson RS, Levin B et al. Aspirin and other NSAIDs and risk of colorectal adenomatous polyps among endoscoped individuals. Cancer Epidemiol Biomarkers Prev 1995; 4: 703–7

    PubMed  CAS  Google Scholar 

  45. 45.

    Sub O, Mettlin C, Petrelli NJ. Aspirin use, cancer, and polyps of the large bowel. Cancer 1993; 72: 1171–7

    Article  Google Scholar 

  46. 46.

    Giovannucci E, Rimm EB, Stampfer MJ, et al. Aspirin use and the risk for colorectal cancer and adenoma in male health professionals. Ann Intern Med 1994; 121: 241–6

    PubMed  CAS  Google Scholar 

  47. 47.

    Logan RF, Little J, Hawtin PG, et al. Effect of aspirin and NSAIDs on colorectal adenomas: case-control study of sub-jects participating in the Nottingham faecal occult blood screening programme. BMJ 1993; 307: 285–9

    PubMed  CAS  Article  Google Scholar 

  48. 48.

    Greenberg ER, Baron JA, Freeman DHJ, et al. Reduced risk of large-bowel adenomas among aspirin users. The Polyp Prevention Study Group. J Nall Cancer Just 1993; 85: 912–6

    CAS  Article  Google Scholar 

  49. 49.

    Nugent KP. Colorectal cancer: surgical prophylaxis and chemoprevention. Ann R Coll Surg Engl 1995; 77: 372–6

    PubMed  CAS  Google Scholar 

  50. 50.

    Giardiello FM. NSAID-induced polyp regression in familial adenomatous polyposis patient. Gastroenterol Clin North Am 1996; 25: 349–62

    PubMed  CAS  Article  Google Scholar 

  51. 51.

    Duris I, Hruby D, Pekarkova B, et al. Calcium chemoprevention in colorectal cancer. Hepatogastroenterology 1996; 43: 152–4

    PubMed  CAS  Google Scholar 

  52. 52.

    Potter JD, Bostick RM, Grandits GA, et al. Hormone replacement therapy is associated with lower risk of adenomatous polyps of the large bowel: the Minnesota Cancer Prevention Research Unit Case-Control Study. Cancer Epidemiol Biomarkers Prev 1996; 5: 779–84

    PubMed  CAS  Google Scholar 

  53. 53.

    Vermorken JB, Claessen AM, van Tinteren H, et al. Active specific immunotherapy for stage II and stage III human colon cancer: a randomised trial. Lancet 1999; 353: 345–50

    PubMed  CAS  Article  Google Scholar 

  54. 54.

    Mayer RJ. Tumors of the large and small intestine. In: Isselbacher KJ, Braunwald E, Wilson JD, et al., editors. Harrison’s principles of internal medicine. New York: McGraw-Hill Inc, 1994: 1424–31

    Google Scholar 

  55. 55.

    Greenlee RT, Murray T, Bolden S, et al. Cancer statistics 2000. CA Cancer J Clin 2000; 50 (1): 7–33

    PubMed  CAS  Article  Google Scholar 

  56. 56.

    Cohen AM, Michelassi F, Galandiuk S. Colorectal cancer surgical practice guidelines. CRC Practice Guideline Committee. Oncology 1997; 11: 1051–7

    PubMed  CAS  Google Scholar 

  57. 57.

    Cancer management manual BCCA, gastrointestinal group. Available from URL: http://www.bccancer.bc.ca/cmm/03-l0.html [Accessed 2003 Sep 19]

  58. 58.

    NICE. Guidance on the use of laparoscopic surgey for colorectal cancer. Technology Appraisal Guidance n.17. London: NICE, 2000 Dec

    Google Scholar 

  59. 59.

    MacDonald IS. Adjuvant therapy for colon cancer. CA Cancer J Clin 1997; 47: 243–56

    PubMed  CAS  Article  Google Scholar 

  60. 60.

    Recommended colorectal cancer surveillance guidelines by the American Society of Clinical Oncology. Available from URL: http://www.asco.org [Accessed 2003 Sep 30]

  61. 61.

    Taplin SH, Barlow W, Urban N, et al. Stage, age, comorbidity, and direct costs of colon, prostate, and breast cancer care. J Nall Cancer Inst 1995; 87: 417–26

    CAS  Article  Google Scholar 

  62. 62.

    Brown ML, Riley GF, Potosky AL. Obtaining long-term disease specific costs of care: application to Medicare enrollees diagnosed with colorectal cancer. Med Care 1999 Dec; 37 (12): 1249–59

    PubMed  CAS  Article  Google Scholar 

  63. 63.

    Ramsey SD, Berry K, Etzioni R. Lifetime cancer-attributable cost of care for long term survivors of colorectal cancer. Am J Gastroenterol 2002 Feb; 97 (2): 440–5

    PubMed  Article  Google Scholar 

  64. 64.

    Brown ML, Fintor L. The economic burden of cancer. In: Greenwald P, Kramer BS, Weed DL, editors. Cancer prevention and control. New York: Marcel Dekker Inc, 1995: 69–81

    Google Scholar 

  65. 65.

    Seifeldin R, Hantasch IJ. The economic burden associated with colon cancer in the USA. Clin Ther 1999; 21 (8): 1370–9

    PubMed  CAS  Article  Google Scholar 

  66. 66.

    Eaddy M, Bramley T, Kozma C, et al. Cost of colorectal cancer in the South Carolina Medicaid (SCM) population. Abstract 1633 (cat. Health Service Research). ASCO International Conference; 2000 May 20–23; New Orleans (LA)

    Google Scholar 

  67. 67.

    Donowitz M. Gastrointestinal disease costs USA at least US$42 billion/year in 2001. Marketletter 2001 May 24

    Google Scholar 

  68. 68.

    Baker MS, Kessler LG, Urban N, et al. Estimating the treatment costs of breast and lung cancer. MedCare 1991; 29: 40–9

    CAS  Google Scholar 

  69. 69.

    Geddes M, Carli S, Ercolanelli M, et al. Colorectal, lung, and breast cancer care during the three years following the diagnosis: a population-based study. Tumori 1996; 82: 210–4

    PubMed  CAS  Google Scholar 

  70. 70.

    Audisio RA, Cazzaniga M, Robertson C, et al. Elective surgery for colerectal cancer in the aged: a clinical-economical evaluation. Br J Cancer 1997; 76: 382–4

    PubMed  CAS  Article  Google Scholar 

  71. 71.

    Chemotherapy for colorectal cancer. Prospects for the future. Inpharma 1996; Suppl. 2: 7

  72. 72.

    Mushinski M. Variation in in-hospital charges for colorectal cancer treatment. Stat Bull Metrop Insur Co 1998; 79: 19–27

    PubMed  CAS  Google Scholar 

  73. 73.

    Etzioni R, Scott RD, Berry C, et al. The impact of including future medical care costs when estimating the costs attributable to a disease: a colorectal cancer case study. Health Econ 2001; 10: 245–56

    PubMed  CAS  Article  Google Scholar 

  74. 74.

    Brown ML, Riley GF, Potosky AL, et al. Obtaining long-term disease specific costs of care: application to Medicare enrollees diagnosed with colorectal cancer. Med Care 1999; 37: 1249–59

    PubMed  CAS  Article  Google Scholar 

  75. 75.

    Khullar SK, DiSario JA. Colon cancer screening: sigmoidoscopy or colonoscopy. Gastrointest Endosc Clin N Am 1997; 7: 365–86

    PubMed  CAS  Google Scholar 

  76. 76.

    Towler B, Irwig L, Glasziou P, et al. A systematic review of the effects of screening for colorectal cancer using the fecal occult blood test, Hemoccult. BMJ 1998; 317: 559–65

    PubMed  CAS  Article  Google Scholar 

  77. 77.

    Heine JA, Rothenberger DA. Cost-effective management of colon and rectal cancer. World J Surg 1991; 15: 597–604

    PubMed  CAS  Article  Google Scholar 

  78. 78.

    Nelson RL. Screening of average-risk individuals for colorectal cancer and postoperative evaluation of patients with colorectal cancer. Surg Clin North Am 1996; 76: 35–45

    PubMed  CAS  Article  Google Scholar 

  79. 79.

    Lieberman DA. Cost-effectiveness model for colon cancer screening. Gastroenterology 1995; 109: 1781–90

    PubMed  CAS  Article  Google Scholar 

  80. 80.

    US Congress Office of Technology Assessment. The cost-effectiveness of colorectal cancer screening in average-risk adults. OTA-BP-H-146. Washington, DC: US Government Printing Office, 1995

    Google Scholar 

  81. 81.

    Marshall JR, Fay D, Lance P. Potential costs of flexible sig-moidoscopy-based colorectal cancer screening. Gastroenterology 1996; 111: 1411–7

    PubMed  CAS  Article  Google Scholar 

  82. 82.

    Norum J. Prevention of colorectal cancer: a cost effectiveness approach to a screening model employing sigmoidoscopy. Ann Oncol 1998; 9: 613–8

    PubMed  CAS  Article  Google Scholar 

  83. 83.

    Gent KW, Bosnian FT, van Blankenstein M, et al. Prevention of colorectal cancer: costs and effectiveness of sigmoidoscopy. Scand J Gastroenterol Suppl 1997; 223: 79–87

    Google Scholar 

  84. 84.

    Weller D, Moss J, Hiller J, et al. Screening for colorectal cancer: what are the costs? Int J Technol Assess Health Care 1995; 11: 26–39

    PubMed  CAS  Article  Google Scholar 

  85. 85.

    Wagner JL, Herdman RC, Wadhwa S. Cost effectiveness of colorectal cancer screening in the elderly. Ann Intern Med 1991; 115: 807–17

    PubMed  CAS  Google Scholar 

  86. 86.

    Virgo KS, Vernava AM, Longo WE, et al. Cost of patient follow-up after potentially curative colorectal cancer treatment. JAMA 1995; 273: 1837–41

    PubMed  CAS  Article  Google Scholar 

  87. 87.

    Rex DK, Mark D, Clarke B, et al. Flexible sigmoidoscopy plus air-contrast barium enema versus colonoscopy for evaluation of symptomatic patients without evidence of bleeding. Gastrointest Endosc 1995; 42: 132–8

    PubMed  CAS  Article  Google Scholar 

  88. 88.

    Frazier Al, Colditz GA, Fuchs CS, et al. Cost effectiveness of screening for colorectal cancer in the general population. JAMA 2000; 284 (15): 1954–61

    PubMed  CAS  Article  Google Scholar 

  89. 89.

    Brown ML, Kessler LG. The use of gene tests to detect hereditary predisposition to cancer: economic considerations. J Nall Cancer Inst 1995; 87: 1131–6

    CAS  Article  Google Scholar 

  90. 90.

    Straus W, Schaffner P, Gold K, et al. Colorectal cancer screening: awareness, utilization, and barriers [abstract]. Value Health 2001; 4 (2): 91

    Google Scholar 

  91. 91.

    Subramanian S, Klosterman M, Amonkar MM, et al. Compliance with CRC screening guidelines: a review. Prev Med. In press

  92. 92.

    Legislative update: final practice expense rulemaking and 1999 Medicare conversion factor and fee schedule rules 1998. Available from URL: www.aeg.gi.org/abtaeg/ldi.html [Accessed 2003 Sep 1]

  93. 93.

    Brown R, Sorensen S, Burrel A, et al. Cost-effectiveness analysis of irinotecan + 5FU/FA alone as first-line therapy in advanced colorectal cancer in the UK [abstract]. Value Health 2001; 4 (2): 54

    Article  Google Scholar 

  94. 94.

    Cunningham D, Falk S, Jackson D. Clinical and economic benefits of irinotecan in combination with 5-FU and folinic acid as first line treatment of metastatic colorectal cancer. Br J Cancer 2002; 86 (11): 1677–83

    PubMed  CAS  Article  Google Scholar 

  95. 95.

    Levy-Piedbois C, Durand-Zalesky I, Juliet H, et al. Cost effectiveness of second line treatment with irinotecan or infusional 5FU in metastatic colorectal cancer. Ann Oncol 2000; 11: 15761

    Article  Google Scholar 

  96. 96.

    Schmitt C, Blijham G, Jolain B, et al. Medical care consumption in a phase III trial comparing irinotecan with infusional 5 FU in patients with metastatic colorectal cancer after 5FU failure. Anticancer Drugs 1999; 10: 617–23

    PubMed  CAS  Article  Google Scholar 

  97. 97.

    Iveson TJ, Hickish T, Schmitt C, et al. Irinotecan in second line treatment of metastatic colorectal cancer: improved survival and cost effect compared with infusional 5FU. Eur J Cancer 1999; 35 (13): 1796–804

    PubMed  CAS  Article  Google Scholar 

  98. 98.

    Neymark N, Adriaenssen I, Schmitt C. Cost-effectiveness analysis of irinotecan compared with best estimated infusional 5FU regimen in patients with advanced colorectal cancer [ab stract 461]. ASCO Conference; 1998 May 16–19; Los Angeles (CA)

    Google Scholar 

  99. 99.

    Simons WR, Grace EM, et al. The comparative economic value of raltritrexed and 5FU plus leucovorin. Eur J Cancer 2000; Suppl. 3: 25

    Google Scholar 

  100. 100.

    Sculpher M, Palmer MK, Heyes A. Costs incurred by patients undergoing advanced colorectal cancer therapy: a comparison of raltitrexed and 5FU plus leucovorin. Pharmacoconomics 2000; 17 (4): 361–70

    CAS  Article  Google Scholar 

  101. 101.

    Groener MGH, van Ineveld BM, Byttebier G, et al. An economic evaluation of Tomudex (raltitrexed) and 5FU plus leucovorin in advanced colorectal cancer. Anticancer Drugs 1999; 10: 1283–8

    Article  Google Scholar 

  102. 102.

    Ollendorf D. Impact of uracil/tegafur plus oral calcium folinate on resource utilization. Oncology 1999; 13 (7 Suppl. 3): 42–3

    Google Scholar 

  103. 103.

    Murad AM, de Andrade CA, Delfino C, et al. Pharmacoeconomic evaluation of tegafur-uracil (UFT) vs 5FU for the management of colorectal cancer in Brazil and Argentina. Clin Drug Invest 1997; 13 (2): 90–8

    CAS  Article  Google Scholar 

  104. 104.

    Ron IG, Lotan A, Inbar MJ, et al. Advanced colorectal carcinoma: redefining the role of oral ftorafur. Anticancer Drugs 1996; 7: 649–54

    PubMed  CAS  Article  Google Scholar 

  105. 105.

    Cavallo MC, Gerzeli S, De Carli C, et al. The cost of treatment for advanced colorectal cancer: a retrospective comparison of five chemotherapy regimens used in a Northern Italy hospital. Pharmacoeconomics 2001; 3 (1): 49–59

    Google Scholar 

  106. 106.

    Norum J, Vonen B, Olsen JA, et al. Adjuvant chemotherapy (5FU and leucovorin) in Dukes’ B and C colorectal cancer: a cost-effectiveness analysis. Ann Oncol 1997; 8: 65–70

    PubMed  CAS  Article  Google Scholar 

  107. 107.

    Lokich JJ, Moore CL, Anderson NR. Comparison of costs for infusion versus bolus chemotherapy administration: analysis of five standard chemotherapy regimens in three common tumors. Part one: model projections for cost based on charges. Cancer 1996; 78: 294–9

    PubMed  CAS  Article  Google Scholar 

  108. 108.

    Brown ML, Nayfield SG, Shibley LM. Adjuvant therapy for stage III colon cancer: economics returns to research and costeffectiveness of treatment. J Nall Cancer Inst 1994; 86: 424–30

    CAS  Article  Google Scholar 

  109. 109.

    Kuvshinoff B. Incremental cost-effectiveness of different chemotherapy regimens in patients with unresectable colorectal liver metastases. Pharmacoeconomics & Outcomes News 1998; 182: 8

    Google Scholar 

  110. 110.

    Durand-Zaleski I, Roche B, Buyse M, et al. Economic implications of hepatic arterial infusion chemotherapy in treatment of non-resectable colorectal liver metastases. J Nall Cancer Inst 1997; 89 (11): 790–5

    CAS  Article  Google Scholar 

  111. 111.

    Sorensen S, Brown R, De Cock E, et al. An analysis of resource use in the treatment of advanced colorectal cancer in the UK [abstract]. Value Health 2001; 4 (2): 90

    Article  Google Scholar 

  112. 112.

    Ross P, Heron J, Cunningham D. Cost of treating advanced colorectal cancer: a retrospective comparison of treatment regimens. Eur J Cancer 1996; 32A Suppl. 5: S13–7

    PubMed  Article  Google Scholar 

  113. 113.

    Blijham G. Impact of second-line therapy with irinotecan on healthcare resource use in patients with metastatic colorectal cancer. Pharmacoeconomics & Outcomes News 1998; 148: 34

    Google Scholar 

  114. 114.

    Durand-Zaleski I, Earlam S, Fordy C, et al. Cost effectiveness of systemic and regional chemotherapy for the treatment of patients with unresectable colorectal liver metastases. Cancer 1998; 83 (5): 882–8

    PubMed  CAS  Article  Google Scholar 

  115. 115.

    Focan C, on behalf of Cancer Chronotherapy Group. Pharmaco-economic comparative evaluation between combination chronotherapy or standard chemotherapy for colorectal cancer [abstract PP17]. Eur J Cancer 2000; 36 (Suppl. 3): 14. 2nd European Conference of the Economics of Cancer; 2000 Sep 3–5; Brussels

    Google Scholar 

  116. 116.

    Trippoli S, Vaiani M, Cattei F, et al. Irinotecan combined with fluorouracil vs fluoruracil alone in metastatic colorectal cancer: cost effectiveness analysis [abstract PP63]. Eur J Cancer 2000; 36 (Suppl 3): 14. 2nd European Conference of the Economics of Cancer; 2000 Sep 3–5; Brussels

    Google Scholar 

  117. 117.

    Douillard JY, Cunningham D, Roth AD. Irinotecan combined with fluorouracil compared with fluorouracil alone as first-line treatment for metastatic colorectal cancer: a multicentre randomised trial. Lancet 2000; 355: 1041–7

    PubMed  CAS  Article  Google Scholar 

  118. 118.

    Cavallo MC, Gerzeli S, De Carli C, et al. The cost of treatment for advanced colorectal cancer: a retrospective comparison of five chemotherapy regimens used in a Northern Italy hospital. Pharmacoeconomics-Italian Research Articles 2001; 3 (1): 4959

    Google Scholar 

  119. 119.

    Nicholls CJ, Cassidy J, Freemantle N, et al. Cost-effectiveness of oxaliplatin in combination with 5-FU/FA compared with 5FU/FA alone. J Drug Assess 2001; 4 (Pt 3): 255–64

    Google Scholar 

  120. 120.

    Nicholls CJ, Cassidy J, Freemantle N, et al. Cost-effectiveness of combination chemotherapy oxaliplatin or inrinotecan plus 5-FU/FA compared with 5-FU/FA alone. J Drug Assessment 2001; 4 (Pt 4): 215–26

    Google Scholar 

  121. 121.

    Giuliani G, Lucioni C, Mazzi S, et al. Economic evaluation of oral capecitabine vs intravenous 5-FU/FA (Mayo regimen) in the treatment of advanced colorectal cancer. Pharmacoeconomics - Italian Research Articles 2002; 4 (1): 31–8

    Google Scholar 

  122. 122.

    Hart WM, Pronk L, Obina S, et al. Cost-effectiveness analysis of irinotecan plus 5-FU/FA compared with 5-FU/FA alone as first line treatment of advanced colorectal cancer [abstract 2262] 38th Annual Meeting ASCO; 2002 May 18–21; Orlando (FL)

    Google Scholar 

  123. 123.

    National Institute for Clinical Excellence (NICE). Guidance on the use of irinotecan, oxaliplatin and raltitrexed for the treatment of advanced colorectal cancer. Technology appraisal no. 33, March 2002. Available from URL: http://www.nice.org.uk [Accessed 2003 Sep 2]

    Google Scholar 

  124. 124.

    Norum J, Balteskard L, Edna TH, et al. Raltritrexed or nordicFLv regimen in metastatic colorectal cancer: a randomized phase II study focusing on QOL, patients’ preferences and health economics. J Chemother 2002; 14 (3): 301–8

    PubMed  CAS  Google Scholar 

  125. 125.

    Postma MI., van Hartskamp D., Jansman FG et al. Cost analysis of capecitabine vs 5-FU/LV for colorectal cancer in patients in the Netherlands [abstract PCN 10]. ISPOR European Conference; 2002 Nov 3–5; Rotterdam

    Google Scholar 

  126. 126.

    van den Hour WB, van den Brink M, Stiggelbout AM, et al. Cost effectiveness analysis of colorectal cancer treatments. Eur J Cancer 2002; 38: 953–63

    Article  Google Scholar 

  127. 127.

    Vorobyov P, Sum M, Avxentieva M, et al. Economical evaluation of raltitrexed vs 5-FU/LV for treatment of advanced colorectal cancer [abstract PCN 6]. ISPOR European Conference; 2002 Nov 3–5; Rotterdam

    Google Scholar 

  128. 128.

    Global cancer rates could increase by 50% to 15 million by 2020. Available from URL: http://who.inUmediacentre/re-leases/2003/pr27/en/print.html [Accessed 2003 Jul 4])

  129. 129.

    Landis SH, Murray T, Bolden S, Wingo PA. Cancer statistics, 1999. CA Cancer J Clin 1999; 49: 8–31

    PubMed  CAS  Article  Google Scholar 

  130. 130.

    Ries LAG, Wingo PA, Miller DS, et al. The annual report of the nation on the status of cancer, 1973–1997, with a special section on colorectal cancer. American Cancer Society. Cancer 2000 May 15; 88 (10): 2398–424

    PubMed  CAS  Article  Google Scholar 

  131. 131.

    Brown ML, Fintor L. The economic burden of cancer. In: Greenwald P, Kramer BS, Weed DL, editiors. Cancer prevention and control. New York: Marcel Dekker, 1995: 69–81

    Google Scholar 

  132. 132.

    Seifeldin R, Hantsch J. The economic burden associated with colon cancer in the United States. Clin Ther 1999; 21 (8): 1370–9

    PubMed  CAS  Article  Google Scholar 

Download references

Acknowledgements

The literature survey was sponsored by Pharmacia Corporation to which one of the authors belongs. To the best of the authors’ knowledge, there are no conflicts of interest relevant to the content of the manuscript.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Dr Alberto Redaelli.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Redaelli, A., Cranor, C.W., Okano, G.J. et al. Screening, prevention and socioeconomic costs associated with the treatment of colorectal cancer. Pharmacoeconomic 21, 1213–1238 (2003). https://doi.org/10.2165/00019053-200321170-00001

Download citation

Keywords

  • Colorectal Cancer
  • Familial Adenomatous Polyposis
  • Metastatic Colorectal Cancer
  • Faecal Occult Blood Testing
  • Folinic Acid