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.

背景：结直肠癌（CRC）是欧洲主要的癌症负担之一，根据基于人群的成本分析，其在2009年给欧盟-27国带来了超过130亿欧元的成本。本研究旨在确定2015年欧洲结直肠癌的经济负担。
方法：对33个欧洲国家的医疗保健支出、非正式护理成本和生产率损失的活动和成本数据进行评估。从国际和国家级来源获得了特定国家的医疗、死亡率、发病率和非正式护理成本的总计数据。计算了初级、门诊、急诊和医院护理以及系统性抗癌治疗（SACT）的成本。计算了由于CRC导致的过早死亡、暂时和永久性缺勤以及无偿非正式护理的成本。分析了医疗保健成本与CRC驱动因素、决定因素和结果之间的相关性。将2015年的医院护理和SACT与2009年的数据集进行了比较。比较了欧洲每个病例的CRC医疗保健成本与CRC生存率和CRC人员、设备和资源。
发现：2015年欧洲结直肠癌的经济负担为191亿欧元。超过总成本的60%（116亿欧元，60.6%）源于因残疾造成的生产力损失（63亿欧元，33.0%）、过早死亡（30亿欧元，15.9%）以及非正式护理者的机会成本（22亿欧元，11.6%）。直接医疗保健成本几乎占总成本的40%（75亿欧元，39.4%），包括医院护理（33亿欧元，占医疗保健成本的43.4%）、SACT（19亿欧元，25.6%）、门诊（13亿欧元，17.7%）、初级（7亿欧元；9.3%）和急诊护理（3亿欧元，3.9%）。
平均管理结直肠癌患者的成本在不同国家之间存在很大差异（259-36,295欧元）。医院护理成本作为医疗保健成本的比例显示出相当大的变化（24%-85%），从2009年到2015年下降了21%。总体而言，医院护理构成了医疗保健支出中的最大比例，但在某些国家，其成本被药品支出显著超越。人均GDP相似的国家在医疗保健支出方面存在很大差异。从2009年到2015年，药品支出增长了214%。
解释：尽管分析的数据包括来自某些国家的非同质来源，并且应谨慎解读，但本研究代表了迄今为止对欧洲结直肠癌经济负担的最全面分析。某些国家在医疗保健成本上的总体支出与患者结果之间并不直接相关。为了确保欧洲公民、患者和社会获得实际利益，用于改善结果的支出必须适应每个国家的挑战。我们的研究结果对指导政策和改善这种常见恶性肿瘤的结果具有重大影响。