Background

Colorectal cancer is one of the leading causes of cancer morbidity and mortality in Europe. We aimed to ascertain the economic burden of colorectal cancer across Europe using a population-based cost-of-illness approach.

Methods

In this population-based cost-of-illness study, we obtained 2015 activity and costing data for colorectal cancer in 33 European countries (EUR-33) from global and national sources. Country-specific aggregate data were acquired for health-care, mortality, morbidity, and informal care costs. We calculated primary, outpatient, emergency, and hospital care, and systemic anti-cancer therapy (SACT) costs, as well as the costs of premature death, temporary and permanent absence from work, and unpaid informal care due to colorectal cancer. Colorectal cancer health-care costs per case were compared with colorectal cancer survival and colorectal cancer personnel, equipment, and resources across EUR-33 using univariable and multivariable regression. We also compared hospital care and SACT costs against 2009 data for the 27 EU countries.

Findings

The economic burden of colorectal cancer across Europe in 2015 was €19·1 billion. The total non-health-care cost of €11·6 billion (60·6% of total economic burden) consisted of loss of productivity due to disability (€6·3 billion [33·0%]), premature death (€3·0 billion [15·9%]), and opportunity costs for informal carers (€2·2 billion [11·6%]). The €7·5 billion (39·4% of total economic burden) of direct health-care costs consisted of hospital care (€3·3 billion [43·4%] of health-care costs), SACT (€1·9 billion [25·6%]), and outpatient care (€1·3 billion [17·7%]), primary care (€0·7 billion [9·3%]), and emergency care (€0·3 billion [3·9%]). The mean cost for managing a patient with colorectal cancer varied widely between countries (€259–36 295). Hospital-care costs as a proportion of health-care costs varied considerably (24·1–84·8%), with a decrease of 21·2% from 2009 to 2015 in the EU. Overall, hospital care was the largest proportion (43·4%) of health-care expenditure, but pharmaceutical expenditure was far higher than hospital-care expenditure in some countries. Countries with similar gross domestic product per capita had widely varying health-care costs. In the EU, overall expenditure on pharmaceuticals increased by 213·7% from 2009 to 2015.

Interpretation

Although the data analysed include non-homogenous sources from some countries and should be interpreted with caution, this study is the most comprehensive analysis to date of the economic burden of colorectal cancer in Europe. Overall spend on health care in some countries did not seem to correspond with patient outcomes. Spending on improving outcomes must be appropriately matched to the challenges in each country, to ensure tangible benefits. Our results have major implications for guiding policy and improving outcomes for this common malignancy.

Funding

Department for Employment and Learning of Northern Ireland, Medical Research Council, Cancer Research UK, Health Data Research UK, and DATA-CAN.

中文翻译：

---

整个欧洲结直肠癌的经济负担：基于人群的疾病成本研究

 背景

结直肠癌是欧洲癌症发病率和死亡率的主要原因之一。我们的目的是使用基于人群的疾病成本方法来确定整个欧洲结直肠癌的经济负担。

 方法

在这项基于人群的疾病成本研究中，我们从全球和国家来源获得了 33 个欧洲国家 (EUR-33) 2015 年结直肠癌的活动和成本数据。获取了特定国家的医疗保健、死亡率、发病率和非正式护理费用的汇总数据。我们计算了初级、门诊、急诊和医院护理以及全身抗癌治疗 (SACT) 费用，以及过早死亡、暂时和永久缺勤以及结直肠癌导致的无偿非正式护理的费用。使用单变量和多变量回归，将每个病例的结直肠癌医疗费用与 EUR-33 的结直肠癌生存率以及结直肠癌人员、设备和资源进行比较。我们还将 27 个欧盟国家的医院护理和 SACT 成本与 2009 年的数据进行了比较。

 发现

2015 年欧洲结直肠癌造成的经济负担为 19·10 亿欧元。非医疗保健总成本为 11·6 亿欧元（占总经济负担的 60·6%），其中包括因残疾导致的生产力损失（6·30 亿欧元 [33·0%]）、过早死亡（欧元） 3·0 亿 [15·9%]），以及非正式护理人员的机会成本（2·20 亿欧元 [11·6%]）。 7·50 亿欧元（占总经济负担的 39·4%）的直接医疗保健费用包括医院护理（3·30 亿欧元[医疗保健费用的 43·4%]）、SACT（1·1 欧元） 90 亿 [25·6%]）、门诊护理（1·30 亿欧元 [17·7%]）、初级护理（70 亿欧元 [9·3%]）和急诊护理（0·3%） 30亿[3·9%]）。各国治疗结直肠癌患者的平均费用差异很大（259-36 295 欧元）。住院费用占医疗保健费用的比例差异很大（24·1–84·8%），欧盟从 2009 年到 2015 年下降了 21·2%。总体而言，医院护理在医疗保健支出中所占比例最大（43·4%），但在一些国家药品支出远远高于医院护理支出。人均国内生产总值相似的国家的医疗保健费用差异很大。在欧盟，2009 年至 2015 年药品总支出增长了 213·7%。

 解释

尽管分析的数据包括来自一些国家的非同质来源，应谨慎解释，但这项研究是迄今为止对欧洲结直肠癌经济负担最全面的分析。一些国家的医疗保健总体支出似乎与患者的治疗结果并不相符。用于改善成果的支出必须与每个国家的挑战适当匹配，以确保切实的效益。我们的结果对于指导这种常见恶性肿瘤的政策和改善结果具有重大影响。

 资金

北爱尔兰就业和学习部、医学研究委员会、英国癌症研究中心、英国健康数据研究中心和 DATA-CAN。