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Survival and costs of colorectal cancer treatment and effects of changing treatment strategies: a model approach

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Abstract

New and emerging advances in colorectal cancer (CRC) treatment combined with limited healthcare resources highlight the need for detailed decision-analytic models to evaluate costs, survival and quality-adjusted life years. The objectives of this article were to estimate the expected lifetime treatment cost of CRC for an average 70-year-old patient and to test the applicability and flexibility of a model in predicting survival and costs of changing treatment scenarios. The analyses were based on a validated semi-Markov model using data from a Norwegian observational study (2049 CRC patients) to estimate transition probabilities and the proportion resected. In addition, inputs from the Norwegian Patient Registry, guidelines, literature, and expert opinions were used to estimate resource use. We found that the expected lifetime treatment cost for a 70-year-old CRC patient was €47,300 (CRC stage I €26,630, II €38,130, III €56,800, and IV €69,890). Altered use of palliative chemotherapy would increase the costs by up to 29%. A 5% point reduction in recurrence rate for stages I–III would reduce the costs by 5.3% and increase overall survival by 8.2 months. Given the Norwegian willingness to pay threshold per QALY gained, society’s willingness to pay for interventions that could result in such a reduction was on average €28,540 per CRC patient. The life years gained by CRC treatment were 6.05 years. The overall CRC treatment costs appear to be low compared to the health gain, and the use of palliative chemotherapy can have a major impact on cost. The model was found to be flexible and applicable for estimating the cost and survival of several CRC treatment scenarios.

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Fig. 1

Reproduced from [5] with kind permission from Sage publishers

Fig. 2

Reproduced from [5] with kind permission from Sage publishers

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Availability of data and material

The Markov model and the data used are presented in a separate article (1). For modelling the Markov model, we used Excel 2016, and for the PSA we used @risk 7.5 for Excel from Palisade.

Abbreviations

5-FU/FA:

Nordic FLv = 5-fluorouracil/folinic acid

CI:

Confidence interval

COI:

Cost-of-illness

CRC:

Colorectal cancer

CrI:

Credible interval

EGFR-inh:

Epidermal growth factor receptor inhibitors (cetuximab/panitumumab)

FLIRI:

A combination of irinotecan and 5-fluorouracil/folinic acid

FLOX:

A combination of oxaliplatin and 5-FU/FA

FOBTs:

Faecal occult blood tests

HRQoL:

Health-related quality of life

LYs:

Life years

NPR:

National Patient Registry

OUS:

Oslo University Hospital

PSA:

Probabilistic sensitivity analysis

PS:

Patient performance status

QALY:

Quality-adjusted life years

WTP:

Willingness to pay

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Acknowledgements

We acknowledge the Department of Health, Nutrition and Management (HEL), The Faculty of Health Sciences, and Oslo and Akershus University College of Applied Sciences for funding Paal Joranger’s doctorate.

Author information

Authors and Affiliations

  1. Norwegian University of Life Sciences, Ås, Norway

    Paal Joranger

  2. Faculty of Health Sciences, OsloMet-Oslo Metropolitan University, 0130, Oslo, Norway

    Paal Joranger & Arne Oshaug

  3. Department of Gastrointestinal Surgery, Oslo University Hospital, 0424, Oslo, Norway

    Arild Nesbakken

  4. K.G. Jebsen Colorectal Cancer Research Centre, Oslo University Hospital, 0424, Oslo, Norway

    Arild Nesbakken

  5. Faculty of Medicine, University of Oslo, Oslo, Norway

    Arild Nesbakken

  6. Department of Oncology and Department of Clinical Science, Haukeland University Hospital, Bergen, Norway

    Halfdan Sorbye

  7. University of Bergen, 5020, Bergen, Norway

    Halfdan Sorbye

  8. Telemark Hospital, Skien, Norway

    Geir Hoff

  9. The Cancer Registry of Norway, Oslo, Norway

    Geir Hoff

  10. University of Oslo, 0316, Oslo, Norway

    Geir Hoff

  11. Institute of Health and Society, Department of Health Management and Health Economics, University of Oslo, Oslo, Norway

    Eline Aas

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  1. Paal Joranger
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Corresponding author

Correspondence to Paal Joranger.

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Conflict of interest

All authors contributed to the work, are aware of, and agree to the submission. Any other person or body with an interest in the manuscript, such as our funders and employers, are also aware and agreed on the submission. Paal Joranger, Eline Aas, and Arne Oshaug declare no support from any organisation for the submitted work, no financial relationships in the previous 3 years with any organisations that might have an interest in the submitted work, and no other relationships or activities that could appear to have influenced the submitted work. In 2017, Geir Hoff received payment from Amgen Norway for giving a lecture at a medical conference. Halfdan Sorbye received Grants and personal fees from Merck, Roche, and Amgen and personal fees from Sanofi during the study. Arild Nesbakken received funding from Helse Sør-Øst for the clinical studies on colorectal cancer (OUS-Aker series). He is a member of a research group in OUS, which has patents on one diagnostic and two prognostic genetic tests for colorectal cancer. He received payment from Amgen Norway for giving a lecture at a medical conference 2018. Financial support for this study was provided entirely by the authors’ employers, which are listed above. The funding agreements ensured the authors’ independence in designing the study, interpreting the data, and writing and publishing the article. The authors declare that they have no competing interests.

Ethics approval and consent to participate

The observational study from 1993 to 2010, including 2049 patients diagnosed with CRC at Oslo University Hospital, was approved by the Regional Ethics Committee (Norway) for Medical Research (REK approval 1.2005.1629). The study with data collected from the National Patient Register (NPR) was approved by the Regional Ethics Committee (Norway). The reference number is S-02113 (2013/83).

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Joranger, P., Nesbakken, A., Sorbye, H. et al. Survival and costs of colorectal cancer treatment and effects of changing treatment strategies: a model approach. Eur J Health Econ 21, 321–334 (2020). https://doi.org/10.1007/s10198-019-01130-6

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