Cost–effectiveness in colorectal cancer: challenges on quality and comparability

Costs in colorectal cancer treatment are rising, especially since the availability of expensive targeted drugs. Comparisons between cost–effectiveness evaluations are restricted to differences in applied methodology, for example, differences in model assumptions and design, healthcare systems. Cost–effectiveness analyses should be performed and reported upon in a standardized manner within a disease area and in particular in oncology to facilitate better comparisons between treatments. Ideally, to evaluate the cost–effectiveness of a treatment in daily practice, models should be based on patient cohort studies or registries with appropriate prospective data collection from a societal perspective. Randomized clinical trials remain most suitable for comparison of treatment strategies and could estimate the budget impact of a novel treatment introduction.

Over the last decades, colorectal cancer death has declined as a result of advances in the prevention, detection and treatment of colorectal cancer [1]. However, cancer care also has a significant impact on healthcare costs. In 2009, European healthcare costs of colorectal cancer (stage I–IV disease) were estimated at €5.57 billion of which €4.04 billion was spent on in-patient care and €565 million was spent on drugs [2]. Over the past years, healthcare expenditures continued to rise. For instance, between 2003 and 2011, the cost of colorectal cancer treatment in The Netherlands has doubled to a total of €427 million. Drug costs – accounting for 5% of the total Dutch colorectal cancer expenditure – almost tripled to a total of €24.1 million (Figure 1) [3].

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