The economic burden of colorectal cancer across Europe: a population-based cost-of-illness study
Menée dans 33 pays européens, cette étude analyse les coûts directs et indirects associés au cancer colorectal pour l'année 2015 (soins de santé, morbidités, traitements anticancéreux, décès prématurés, incapacité, etc.)
Background : Colorectal cancer is one of the leading causes of cancer morbidity and mortality inEurope. We aimed to ascertain the economic burden of colorectal cancer across Europe using a population-based cost-of-illness approach. Methods : In this population-based cost-of-illness study, we obtained 2015 activity and costingdata for colorectal cancer in 33 European countries (EUR-33) from global and nationalsources. Country-specific aggregate data were acquired for health-care, mortality,morbidity, and informal care costs. We calculated primary, outpatient, emergency,and hospital care, and systemic anti-cancer therapy (SACT) costs, as well as the costs of premature death, temporary and permanent absence from work, and unpaid informalcare due to colorectal cancer. Colorectal cancer health-care costs per case were comparedwith colorectal cancer survival and colorectal cancer personnel, equipment, and resourcesacross EUR-33 using univariable and multivariable regression. We also compared hospitalcare and SACT costs against 2009 data for the 27 EU countries. Findings : The economic burden of colorectal cancer across Europe in 2015 was €19·1 billion.The total non-health-care cost of €11·6 billion (60·6% of total economic burden) consistedof loss of productivity due to disability (€6·3 billion [33·0%]), premature death(€3·0 billion [15·9%]), and opportunity costs for informal carers (€2·2 billion [11·6%]).The €7·5 billion (39·4% of total economic burden) of direct health-care costs consistedof hospital care (€3·3 billion [43·4%] of health-care costs), SACT (€1·9 billion [25·6%]),and outpatient care (€1·3 billion [17·7%]), primary care (€0·7 billion [9·3%]), andemergency care (€0·3 billion [3·9%]). The mean cost for managing a patient with colorectalcancer varied widely between countries (€259–36 295). Hospital-care costs as a proportionof health-care costs varied considerably (24·1–84·8%), with a decrease of 21·2% from2009 to 2015 in the EU. Overall, hospital care was the largest proportion (43·4%)of health-care expenditure, but pharmaceutical expenditure was far higher than hospital-careexpenditure in some countries. Countries with similar gross domestic product per capitahad widely varying health-care costs. In the EU, overall expenditure on pharmaceuticalsincreased by 213·7% from 2009 to 2015. Interpretation : Although the data analysed include non-homogenous sources from some countries andshould be interpreted with caution, this study is the most comprehensive analysisto date of the economic burden of colorectal cancer in Europe. Overall spend on healthcare in some countries did not seem to correspond with patient outcomes. Spendingon improving outcomes must be appropriately matched to the challenges in each country,to ensure tangible benefits. Our results have major implications for guiding policyand improving outcomes for this common malignancy.