Defining the economic burden of colorectal cancer across Europe: providing the evidence for strengthening value-based cancer systems
Objective: To determine the economic burden of colorectal cancer (CRC) across Europe. Design: Activity and costing data were evaluated for healthcare expenditure, informal care costs and productivity losses. Results: The economic burden of CRC across Europe in 2015 was €19.6 billion. Almost two-thirds of the total cost (€12.6B, 64.2%) arose from loss of productivity due to disability (€6.3B, 32.2%), premature death (€4.1B, 20.8%) and opportunity costs for informal carers (€2.2B, 11.2%). Direct healthcare costs only represent about one-third of the total (€7.0B, 35.8%), comprising hospital care (€3.3B, 46.5% of healthcare costs), systemic anti-cancer therapy (€1.9B, 27.5%), and outpatient (€0.8B, 11.5%), primary (€0.7B; 10.0%) and emergency care (€0.3B, 4.5%). The average cost for managing a colorectal cancer patient varied widely between countries (€191-€23,610). Hospital care costs showed considerable variation as a proportion of healthcare costs (24%-84%). Overall, hospital care comprised the largest proportion of healthcare expenditure, but it was significantly outstripped by pharmaceutical expenditure in some countries. Countries with similar GDP per capita had widely varying healthcare expenditures. Expenditure on pharmaceuticals rose by 214% from 2009 to 2015. Conclusions: This study represents the most comprehensive analysis of the economic burden of colorectal cancer in Europe. Substantial variation in overall spend in certain countries did not correlate with patient outcomes. Spending on improving outcomes must be appropriate to the challenges in each country, in order to ensure tangible benefits for European citizens, patients and society. Our results have major implications for guiding policy and improving outcomes for this common malignancy.
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