Cost of diagnostic and therapeutic management of colorectal cancer according to stage at diagnosis in the Calvados D�partement, France

Abstract

Screening for colorectal cancer is a high priority of public health in France, as in other Western countries. In spite of its effectiveness, shown by randomized studies, no national program of colorectal screening using fecal occult blood test has yet implemented, due mainly to the low sensitivity of the screening test and to the weak participation of the target population. Economic studies can make a useful contribution to helping the decision makers of public health. One of the advantages to the organization of a screening program is a financial saving generated by advance in diagnosis. To investigate this hypothesis this study assessed the cost of the management of colorectal cancer according to its stage of extension using medical data from a specialized cancer registry and economic data from the national Social Security System. No significant decrease in the first-year costs of treating colorectal cancer was found with advance of diagnosis. The average cost for the first year of management of colorectal cancer after diagnosis was of Euro 21,918. According to the stage of diagnosis, the highest average cost was for the subjects with a cancer with lymph node involvement, with a cost of Euro 31,110. Cancers with an invasion limited to the submucosa or visceral metastases had an equivalent cost, respectively, of Euro 17,579 and of Euro 17,384. With a limited power due to low strength, these results suggest that the organization of a colorectal cancer screening program does not significantly reduce in the first year the total cost of management of this cancer. However, the organization of such screening remains a public health priority, prevention aiming only to allow subjects to live in good health as long as possible,and not to save money.

Economic impact of simplified de Gramont regimen in first-line therapy in metastatic colorectal cancer

“…Another additional approach is to optimize the economic profile of daily practices. Considering the economic burden of advanced stages, it is a major concern in patients with colorectal cancer [4,27]. Several studies have stressed the major impact of chemotherapy infusion costs among the total palliative treatment costs.…”

“…The economic profile of irinotecan has been judged as an acceptable option in first-and second-line therapy [9,18,22]. Knowing that hospital admission is the major cost pattern in managing advanced colorectal cancer, an interesting option to optimize the cost of treatment can be based on the analysis of chemotherapy schedules [4,26]. The schedule of fluorouracil administration has been shown a determining factor in terms of cost in several studies [15,16,28].…”

Cost‐effectiveness analysis of two strategies for mass screening for colorectal cancer in France

“…Costs of treating cancers with regard to diagnostic stage were estimated using data from the Digestive Tumour Registry of Calvados and Social Security data on reimbursements for treating all CRCs incident in the Department of Calvados during the period 1st September 1997 to 31st August 1998 [21]. They were constituted of: hospital care (both public and private) and care given in the medical departments of retirement homes; outpatient care (specialised or non-specialised medical consultations, medical and paramedical acts); transportation for medical reasons; medical purchases such as pharmaceutical products and prosthesis (colostomy bags); and assistance provided to patients such as daily payments and other allowances (disability with or without recourse to a third person).…”

The relevance of unrelated costs internal and external to the healthcare sector to the outcome of a cost-comparison analysis of secondary prevention: the case of general colorectal cancer screening in the German population

“…This means that, as a consequence of secondary prevention, analyses should consider the costs of the last year of life. If, from a strictly cost-based perspective, one disagrees about the benefits of secondary prevention, it can generally be said that the overall goal is prevention aimed only at allowing individuals to live in good health as long as possible, rather than saving money [3].…”

“…The study calculates the average annual treatment cost of €15,000 as the cost of dying, discounted to the time of survival. 3 Applying this sum to the number of deaths attributable to CRC, the unrelated costs of the last year of life amount to €242,333,930.…”