LB26
Costs to the health services of treating colorectal cancer: the impact of biological agents
Lesley Tilson1, Linda Sharp2, Cathal Walsh3, Alan O'Ceilleachair2, Cara Usher1, Michael Barry1, Harry Comber2
1National Centre for Pharmacoeconomics, Dublin, Ireland, 2National Cancer Registry Ireland, Cork, Ireland, 3Trinity College Dublin, Ireland
Background
Treatment options for colorectal cancer has increased in recent years. The
addition of biological agents such as bevacizumab and cetuximab to chemotherapy
regimes may improve survival for patients with advanced disease. We estimated
(1) average lifetime costs of treating colorectal cancer to the health services
in Ireland, and (2) explored the impact of biological agents on these costs.
Method
Treatment pathways were constructed for each stage of colon and rectal
cancer from guidelines and expert clinical opinion and implemented in a
decision tree model. Healthcare resource use associated with diagnosis,
treatment and follow-up was estimated from data held by the National Cancer
Registry Ireland (n=1,498) and two local hospitals (n=155 and 142). Use of
biological agents were based on expert oncology opinion. Unit costs of
hospitalisation, procedures/tests, and therapies were derived from
diagnostic-related group costs, hospital finance and pharmacy departments,
clinical opinion and literature review. Future costs of follow-up were
discounted at 4% over 5 years. Levels of use (0%, 20%, 67%, 80% of eligible
patients), duration (3, 5, 8 months), and costs (+/-20%) of biological agents
were varied in sensitivity analysis.
Results
The average lifetime cost per patient (stage-weighted) was estimated to be
33,288 if no patients received biological agents. This increased with the
proportion of eligible patients receiving biological agents (20%, 35,174; 67%,
39,607; 80%, 40,833). The impact was greatest on stage IV disease (0%
receiving biological agents, 24,040; 80%, 39,039). Cost estimates were
sensitive to variations in duration of use and costs of agents. Biological
agents were estimated to contribute 15-30% of the cost of treating colorectal
cancer.
Conclusion
These results illustrate the impact of biologic agents on the costs to the
health services of treating colorectal cancer. Whether the cost is justified by
longer survival can only be assessed in cost-effectiveness analyses.
