Hospital health care resource utilization and costs of colorectal cancer during the first 3‐year period following diagnosis in Switzerland

Abstract

In industrialized countries, colorectal cancer is a leading cause of morbidity and mortality. Decisions on colorectal cancer screening are based on cost-effectiveness analyses that rely on colorectal cancer cost studies. Additionally, the study of the resource utilization pattern may lead to cost-saving strategies in the care of colorectal cancer. To estimate hospital resource utilization, the use of various therapy modalities and costs of colorectal cancer cases undergoing surgery during the first 3 years following the diagnosis at a Swiss university hospital. Consecutive colorectal cancer patients from 1997 to 1998 were identified using the surgery database of the University Hospital of Basel and followed for a period of 3 years. In-hospital resource utilization and costs were retrieved from the computerized administrative records. Treatment outside of the hospital during the study period constituted an exclusion criterion. Eighty-three (94%) of 89 patients undergoing surgery for colorectal cancer were included in the study, 58 with colon cancer and 25 with rectal cancer. The average ages were 70.3 and 63.6 years, respectively. Overall, 59% of the patients were treated with surgery alone, 27% also had chemotherapy and 15% received additional chemoradiotherapy. These percentages and resource utilization varied broadly between the two colorectal cancer groups. On average, patients were admitted to the hospital 2.7 times and the hospital length of stay amounted to 35 days. They were visited by doctors 69 times, and examined with colonoscopy, ultrasonography and computerized tomography 2.7, 3.2 and 2.4 times, respectively. Mean costs incurred for rectal cancer (US dollars 40,230) were about 22% higher than for colon cancer patients (US dollars 33,079). Hospitalization and surgical therapy generated the greatest costs. Expenses were highest for the first year and with more severe disease stages at diagnosis. Colorectal cancer is an expensive disease. Economic analyses on screening should take into account the large resource utilization and cost variability by performing sensitivity analysis on broad cost ranges. Furthermore, they should consider stage shifting at diagnosis and include stage-specific costs.