Objective
Management options for colorectal cancer
have expanded in recent years. We estimated average
lifetime cost of care for colorectal cancer in Ireland in
2008, from the health care payer perspective.
Method
A decision tree model was developed in Microsoft
EXCEL. Site and stage-specific treatment pathways
were constructed from guidelines and validated by expert
clinical opinion. Health care resource use associated with
diagnosis, treatment and follow-up were obtained from the
National Cancer Registry Ireland (n=1,498 cancers diagnosed
during 2004–2005) and three local hospital databases
(n=155, 142 and 46 cases diagnosed in 2007). Unit costs
for hospitalisation, procedures, laboratory tests and radiotherapy
were derived from DRG costs, hospital finance
departments, clinical opinion and literature review.
Chemotherapy costs were estimated from local hospital
protocols, pharmacy departments and clinical opinion.
Uncertainty was explored using one-way and probabilistic
sensitivity analysis.
Results
In 2008, the average (stage weighted) lifetime cost
of managing a case of colorectal cancer was €39,607. Average
costs were 16% higher for rectal (€43,502) than colon
cancer (€37,417). Stage I disease was the least costly
(€23,688) and stage III most costly (€48,835). Diagnostic
work-up and follow-up investigations accounted for 4 and5%
of total costs, respectively. Cost estimates were most sensitive
to recurrence rates and prescribing of biological agents.
Conclusion
This study demonstrates the value of using
existing data from national and local databases in contributing
to estimating the cost of managing cancer. The
findings illustrate the impact of biological agents on costs
of cancer care and the potential of strategies promoting
earlier diagnosis to reduce health care resource utilisation
and care costs.