Longitudinal economic consequences of colorectal cancer in a university hospital setting

Colorectal cancer is an important cause of morbidity and mortality in Europe. Medical interventions improve health outcomes, but may come at a considerable cost for the health care system and for patients. There is a need for so called incidence-based cost-analyses, in order to better understand the potential impact of new types of prevention and treatment.

The objective of this study was to map--both from the patient and the health insurance perspective--the longitudinal costs of colorectal cancer in a university hospital setting. In addition, the average monthly cost per patient and the costs during the last year of life were investigated.

The incidence-based analysis was conducted on data from 539 patients, who were treated for colorectal cancer in the Ghent University Hospital between July 1989 and August 2008. Data were obtained from all identified invoices and analysed from the perspective of both the health insurance and the patient. The costs were split in three major categories: drugs, hospital stay and fees. The follow-up period was divided into three periods: before recurrence, between recurrence and metastatic disease, and from metastatic disease until death.

The total cumulative cost for an average follow-up of 3 years and 3 months was Euro37,696.2, the cost for rectal cancer and colon cancer being similar (Euro38,058 versus Euro37,268 respectively). Patients pay on average 10% of the cost, whereby medical fees are the main contributor to this cost. The total cost for patients who died during followup is higher (p = 0.297) compared to the cost in those who were still alive at the end of the follow-up period. The costs are highest during the last year of life. There was a significant difference (p = 0.049) in costs between patients with (Euro41,256.4) and without (Euro35,525.4) involved Lymph Nodes (LN) at the time of diagnosis.

This study provides insight in the total longitudinal costs of colorectal cancer, and on the drivers of these costs within pre-defined periods in the progress of the disease. Taking into consideration some inherent limitations of our data and methods, such data are relevant and informative to health care policy makers and should be investigated more frequently.