Defining the economic burden of colorectal cancer across Europe
Background: Colorectal cancer (CRC) is one of the leading cancer burdens in Europe and was determined in population-based cost analysis to cost the EU-27 over €13 billion in 2009. We aim to ascertain the economic burden of CRC across Europe in 2015. Methods: Activity and costing data were evaluated for healthcare expenditure, informal care costs and productivity losses in 33 European countries. Country-specific aggregate data was acquired for healthcare, mortality, morbidity, and informal care costs, from international and national sources. Primary, outpatient, emergency, and hospital care, and systemic anti-cancer therapy (SACT) costs were calculated. Costs of premature death, temporary and permanent absence from work, and unpaid informal care due to CRC were calculated. Correlations between healthcare costs and CRC drivers, determinants, and outcomes were analysed. 2015 hospital care and SACT were compared to the 2009 data set. CRC healthcare costs per case were compared to CRC survival and CRC personnel, equipment, and resources across Europe. Findings: The economic burden of CRC across Europe in 2015 was €19·1 billion. Over sixty percent of the total cost (€11·6B, 60·6%) arose from loss of productivity due to disability (€6·3B, 33·0%), premature death (€3·0B, 15·9%) and opportunity costs for informal carers (€2·2B, 11·6%). Direct healthcare costs represented nearly forty percent of the total (€7·5B, 39·4%), comprising hospital care (€3·3B, 43·4% of healthcare costs), SACT (€1·9B, 25·6%), and outpatient (€1·3B, 17·7%), primary (€0·7B; 9·3%) and emergency care (€0·3B, 3·9%). The average cost for managing a colorectal cancer patient varied widely between countries (€259-€36,295). Hospital care costs showed considerable variation as a proportion of healthcare costs (24%-85%) with a decrease of 21% from 2009 to 2015. 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. Interpretation: Although the data analysed include non-homogenous sources from certain countries and should be interpreted with a degree of caution, this study represents the most comprehensive analysis to date of the economic burden of colorectal cancer in Europe. Substantial variation in overall spend on healthcare costs in certain countries is not in direct correlation to 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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