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Survival and costs of colorectal cancer treatment and effects of changing treatment strategies: a model approach


  • Paal Joranger

    (Norwegian University of Life Sciences
    OsloMet-Oslo Metropolitan University)

  • Arild Nesbakken

    (Oslo University Hospital
    K.G. Jebsen Colorectal Cancer Research Centre, Oslo University Hospital
    University of Oslo)

  • Halfdan Sorbye

    (Haukeland University Hospital
    University of Bergen)

  • Geir Hoff

    (Telemark Hospital
    The Cancer Registry of Norway
    University of Oslo)

  • Arne Oshaug

    (OsloMet-Oslo Metropolitan University)

  • Eline Aas

    (University of Oslo)


New and emerging advances in colorectal cancer (CRC) treatment combined with limited healthcare resources highlight the need for detailed decision-analytic models to evaluate costs, survival and quality-adjusted life years. The objectives of this article were to estimate the expected lifetime treatment cost of CRC for an average 70-year-old patient and to test the applicability and flexibility of a model in predicting survival and costs of changing treatment scenarios. The analyses were based on a validated semi-Markov model using data from a Norwegian observational study (2049 CRC patients) to estimate transition probabilities and the proportion resected. In addition, inputs from the Norwegian Patient Registry, guidelines, literature, and expert opinions were used to estimate resource use. We found that the expected lifetime treatment cost for a 70-year-old CRC patient was €47,300 (CRC stage I €26,630, II €38,130, III €56,800, and IV €69,890). Altered use of palliative chemotherapy would increase the costs by up to 29%. A 5% point reduction in recurrence rate for stages I–III would reduce the costs by 5.3% and increase overall survival by 8.2 months. Given the Norwegian willingness to pay threshold per QALY gained, society’s willingness to pay for interventions that could result in such a reduction was on average €28,540 per CRC patient. The life years gained by CRC treatment were 6.05 years. The overall CRC treatment costs appear to be low compared to the health gain, and the use of palliative chemotherapy can have a major impact on cost. The model was found to be flexible and applicable for estimating the cost and survival of several CRC treatment scenarios.

Suggested Citation

  • Paal Joranger & Arild Nesbakken & Halfdan Sorbye & Geir Hoff & Arne Oshaug & Eline Aas, 2020. "Survival and costs of colorectal cancer treatment and effects of changing treatment strategies: a model approach," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(3), pages 321-334, April.
  • Handle: RePEc:spr:eujhec:v:21:y:2020:i:3:d:10.1007_s10198-019-01130-6
    DOI: 10.1007/s10198-019-01130-6

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    References listed on IDEAS

    1. Aas, Eline, 2009. "Cost-effectiveness of screening for colorectal cancer with once-only flexible sigmoidoscopy and faecal occult blood test," HERO Online Working Paper Series 2008:6, University of Oslo, Health Economics Research Programme.
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    3. Drummond, Michael F. & Sculpher, Mark J. & Torrance, George W. & O'Brien, Bernie J. & Stoddart, Greg L., 2005. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 3, number 9780198529453, Decembrie.
    4. Meltzer, David, 1997. "Accounting for future costs in medical cost-effectiveness analysis," Journal of Health Economics, Elsevier, vol. 16(1), pages 33-64, February.
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    More about this item


    Colorectal cancer; Markov model; Cost; Surgery; Chemotherapy; Analyse innovations;
    All these keywords.

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets


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