Treatment pathways and associated costs of metastatic colorectal cancer in Greece

Abstract

Objectives Colorectal cancer (CRC) is the second leading cause of cancer in Europe, with 1.931.590 people newly diagnosed in 2020. The purpose of this study is the investigation of treatment options and healthcare resource metastatic CRC (mCRC) in Greece. Methods This study is based on the information collected in November 2020 by an expert panel comprising of 6 medical oncologists from major public and private centers around Greece. A 3-round survey was undertaken, according to Delphi method. The treatment phases studied were: pre-progression; disease progression and terminal care. Pharmaceutical costs and resource utilization data were considered from the perspective of the Greek National Services Organization (EOPYY). RESULTS: Experts agreed that the anticipated prevalence of RAS mutation in mCRC is 47% (30% RAS/BRAF WT Left, 17% RAS/BRAF WT Right); 8% BRAF while, MSI-H/dMMR are found in 5% of mCRC tumors. Based on mutational status, 74.8% of patients receive biological targeted therapies in combination with fluoropyrimidine/based combination chemotherapy, as 1st line treatment, and 25.2% combination chemotherapy alone. At 2nd line, 58.6% of patients receive biological targeted therapies in combination with chemotherapy, 25.4% immunotherapy, 11% combination chemotherapy and 5% biological targeted therapies. At 3rd line 56% of patients receive combination chemotherapy, 28% biological targeted therapies, 10% biological targeted therapies in combination with chemotherapy and 6% immunotherapy. The weighted annual cost (pharmaceuticals and resource use cost) in 1st line per mCRC patient was calculated at €28,407, in 2nd line €33,568, in 3rd line €25,550. The annual cost beyond 3rd line per patient regardless mutation was €19,501 per mCRC patient. Conclusions mCRC is a societal challenge for healthcare systems as the treatment is more prolonged but expand patients’ survival. Thus, reimbursement decisions should be based not just on the cost of the treatment, but on the magnitude of the benefit of its treatment on patients’ survival and quality of life.

Association of Metastatic Colorectal Cancer and its Treatment

“…These results were comparable to the previous studies. [20,21] According to mutational status as first line therapy, frequency of biological targeted therapies in combination with fluoropyrimidine/based combination chemotherapy was 105 (70%), and frequency of combination chemotherapy alone was among 45 (30%) cases. We found 80 (53.3%) patients received biological targeted therapies in combination with chemotherapy, frequency of immunotherapy was 35 (23.3%), combination chemotherapy in 20 (13.3%) and biological targeted therapies in 15 (10%) cases at second line while at third line, combination chemotherapy was received in 90 (60%) cases, frequency of biological targeted therapies was 40 (26.7%), biological targeted therapies in combination with chemotherapy in 13 (8.7%) cases and immunotherapy in 7 (4.7%) cases.…”

“…For every additional line of illness progression, the cost to the health care system approximately triples in contrast to monthly resource utilisation. [20] Prevention of CRC is undoubtedly the best approach for both individuals and society as a whole, notwithstanding recent advances in therapy. Endoscopic procedures such as flexible sigmoidoscopy or colonoscopy should be used to screen for CRC, according to European Union recommendations issued in 2012 [24].…”

Prediction and the influencing factor study of colorectal cancer hospitalization costs in China based on machine learning-random forest and support vector regression: a retrospective study

“…Cases with missing or repeated data on the first page of the case, or with obvious errors, are excluded, 1,590 cases were eventually included. After searching for relevant reports (17)(18)(19), We included as input variables gender, age, level of procedure, number of hospitalizations, length of stay, occupation, marital status, major procedure, Charlson Comorbidity Index(CCI) score, and the output variable was hospitalization costs (Table 1). Identification of the corresponding Charlson comorbidity by ICD-10 codes in the other diagnoses on the first page of the case and direct calculation of the CCI score (20).…”