Cost profiles of colorectal cancer patients in Italy based on individual patterns of care

摘要

Due to changes in cancer-related risk factors, improvements in diagnostic procedures and treatments,udand the aging of the population, in most developed countries cancer accounts for an increasing proportion ofudhealth care expenditures. The analysis of cancer-related costs is a topic of several economic and epidemiologicaludstudies and represents a research area of great interest to public health planners and policy makers. In Italy studiesudare limited either to some specific types of expenditures or to specific groups of cancer patients. Aim of the paperudis to estimate the distribution of cancer survivors and associated health care expenditures according to a diseaseudpathway which identifies three clinically relevant phases: initial (one year following diagnosis), continuing (betweenudinitial and final) and final (one year before death).udMethods: The methodology proposed is based on the reconstruction of patterns of care at individual level byudcombining different data sources, surveillance data and administrative data, in areas covered by cancer registration.udResults: A total colorectal cancer-related expenditure of 77.8 million Euros for 18012 patients (corresponding toudabout 4300 Euros per capita) is estimated in 2006 in two Italian areas located in Tuscany and Veneto regions,udrespectively. Cost of care varies according to the care pathway: 11% of patients were in the initial phase, andudconsumed 34% of total expenditure; patients in the final (6%) and in the continuing (83%) phase consumed 23%udand 43% of the budget, respectively. There is an association between patterns of care/costs and patientsudcharacteristics such as stage and age at diagnosis.udConclusions: This paper represents the first attempt to attribute health care expenditures in Italy to specific phasesudof disease, according to varying treatment approaches, surveillance strategies and management of relapses,udpalliative care. The association between stage at diagnosis, profile of therapies and costs supports the idea thatudprimary prevention and early detection play an important role in a public health perspective. Results from this pilotudstudy encourage the use of such analyses in a public health perspective, to increase understanding of patientudoutcomes and economic consequences of differences in policies related to cancer screening, treatment, andudprograms of care