Abstract
ObjectivesColorectal cancer (CRC) is the second leading cause of cancer in Europe, with 1.931.590 people newly diagnosed in 2020. The purpose of this study is the investigation of treatment options and healthcare resource metastatic CRC (mCRC) in Greece.MethodsThis study is based on the information collected in November 2020 by an expert panel comprising of 6 medical oncologists from major public and private centers around Greece. A 3-round survey was undertaken, according to Delphi method. The treatment phases studied were: pre-progression; disease progression and terminal care. Pharmaceutical costs and resource utilization data were considered from the perspective of the Greek National Services Organization (EOPYY). RESULTS: Experts agreed that the anticipated prevalence of RAS mutation in mCRC is 47% (30% RAS/BRAF WT Left, 17% RAS/BRAF WT Right); 8% BRAF while, MSI-H/dMMR are found in 5% of mCRC tumors. Based on mutational status, 74.8% of patients receive biological targeted therapies in combination with fluoropyrimidine/based combination chemotherapy, as 1st line treatment, and 25.2% combination chemotherapy alone. At 2nd line, 58.6% of patients receive biological targeted therapies in combination with chemotherapy, 25.4% immunotherapy, 11% combination chemotherapy and 5% biological targeted therapies. At 3rd line 56% of patients receive combination chemotherapy, 28% biological targeted therapies, 10% biological targeted therapies in combination with chemotherapy and 6% immunotherapy. The weighted annual cost (pharmaceuticals and resource use cost) in 1st line per mCRC patient was calculated at €28,407, in 2nd line €33,568, in 3rd line €25,550. The annual cost beyond 3rd line per patient regardless mutation was €19,501 per mCRC patient.ConclusionsmCRC is a societal challenge for healthcare systems as the treatment is more prolonged but expand patients’ survival. Thus, reimbursement decisions should be based not just on the cost of the treatment, but on the magnitude of the benefit of its treatment on patients’ survival and quality of life.
Highlights
Colorectal cancer (CRC) is the third most frequent cancer in the world, accounting for 10% of new cancer cases in 2020 [1]
For the purposes of data collection, a questionnaire was developed, regarding the therapeutic and pharmaceutical algorithm followed in Greece for all types of metastatic CRC (mCRC), followed by resource use consumption at all stages
The mean age of mCRC patient reported by the expert panel is 64.6 years, with 1.79 [Standard Deviation (S.D). 0.23] body surface area (BSA) and 47.3% male
Summary
Colorectal cancer (CRC) is the third most frequent cancer in the world, accounting for 10% of new cancer cases in 2020 [1]. In Europe, CRC is the second most frequent cancer. In 2020, CRC represented approximately 12.9% of new cancer cases in Europe [3]. The expected increasing incidence rates of CRC is thought to be driven by various factors such as population ageing, dietary changes, increased diagnosis, and Sougklakos et al Cost Effectiveness and Resource Allocation (2022) 20:7 intensified survival [5]. The aforementioned factors, CRC is observed to occur more frequently in men (281,714 new cases) compared with women (238,106 new cases), yet it is not substantially different [1]. The slight disparities observed between CRC incidence in men and women is possibly influenced by the difference in behavioural and physiological patterns. Women tend to undergo screening more frequently, have a healthier lifestyle, and are more frequent users of hormone therapy which is associated with decreased risk of CRC [6]
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