Colorectal cancer treatment costs: Estimation for Germany using health insurance data and comparison of the cost estimates with other countries

Background: Colorectal cancer (CRC) screening has been offered in Germany since more than 30 years but there is a lack of studies analyzing its cost-effectiveness. The cost of CRC treatment is an important parameter in such analyses. We aimed to estimate CRC treatment cost for Germany using health insurance data from the Techniker Krankenkasse (TK) and to compare the estimates to other countries.

Methods: We included persons who were continuously TK-insured between 2005–2010: A) Cases: Persons with a hospital discharge diagnosis of CRC (ICD C18-C20) between 2007–2010 and no such a diagnosis between 2005–2006 (to focus on incident CRC cases); B) Controls: Persons without a diagnosis of CRC during the observation period, matched to CRC cases by age and sex (matching factor: 1 : 5). We considered in-patient, out-patient and drug costs and calculated incremental costs as the difference in means between cases and controls. Costs were divided into initial phase of care, intermediate phase and end-of-life phase. Stage-specific costs were estimated making assumptions on the distribution of CRC cases and costs by stage. We conducted a systematic literature review of cost-effectiveness analyses on CRC screening published since 2005 to compare our cost estimates to other countries.

Results: According to preliminary results, the mean incremental costs for the initial phase of care, the intermediate phase and the end-of-life phase were 30.229€, 4.309€, and 61.361€, respectively. Late-stage costs for the three phases were estimated to be 15.142€, 5.003€, and 11.562€ higher compared to early-stage costs. Regarding the comparison with other industrialized countries the estimates are plausible despite heterogeneity in the methods used to derive the cost estimates.

Conclusion: Our estimates provide a sound basis for subsequent cost-effectiveness analyses to weigh up the potential savings in treatment costs against the resources required for CRC screening.

colorectal cancer - treatment costs