Costs of treatment of colorectal cancer in different settings in Germany

Abstract

The objective of this study was to evaluate the cost implications of different settings (inpatient, outpatient/day clinic, or office-based oncologists) for the administration of standard fluoropyrimidine therapies, i.e., Mayo Clinic and Arbeitsgemeinschaft Internistische Onkologie (AIO)/Ardalan regimen, and to compare the results with the cost of oral capecitabine in Germany. In total, 89 quarterly fee-listings from 26 patients provided by 5 office-based oncologists were analyzed. Physician's services, drug costs, pharmacy costs, and costs for implantable venous port systems and single-use pumps were considered. Findings were transferred to the hospital setting. A third-party payer perspective was applied. Quarterly treatment costs for the Mayo Clinic regimen varied between <euro> 2,036 and <euro> 10,569, and between <euro> 1,294 and <euro> 10,179 for the AIO/Ardalan regimen depending on the treatment setting. Projected costs for capecitabine were <euro> 2,338. No hospitalization was considered to be necessary for capecitabine due to its oral administration route. The most expensive treatment options were the AIO/Ardalan protocol in the office-based setting and the Mayo Clinic protocol in the hospital setting. Capecitabine emerged as the cheapest option in the office-based setting. Overall, the cheapest option was the AIO/Ardalan protocol in municipal hospitals. However, municipal hospitals are unlikely to cover their costs in this situation. Substantial cost savings without incurring losses to providers may be realized if patients are transferred from the hospital setting to the office-based setting and treated with capecitabine.

Economic impact of simplified de Gramont regimen in first-line therapy in metastatic colorectal cancer

“…In particular, the major impact of the continuous 5-FU infusion costs has been established [9,15,24,28,32]. This 5-FU infusion cost has supported the favorable trends reported by recent economic studies for the use of raltitrexed, capecitabine, and tegafur [15,16,19,24,32]. To strengthen the base of future analyses it appears relevant to provide information about the distribution costs according to various schedules of continuous 5-FU infusion.…”

“…To strengthen the base of future analyses it appears relevant to provide information about the distribution costs according to various schedules of continuous 5-FU infusion. Several analyses have studied the costs related to conventional infusional 5-FU schedules [15,16,28].…”

“…Knowing that hospital admission is the major cost pattern in managing advanced colorectal cancer, an interesting option to optimize the cost of treatment can be based on the analysis of chemotherapy schedules [4,26]. The schedule of fluorouracil administration has been shown a determining factor in terms of cost in several studies [15,16,28].…”

Economic Impact of Alternative Adjuvant Chemotherapy Regimens for Stage III Colon Cancer

“…Earlier controlled studies have shown that patients who are randomized to adjuvant chemotherapy usually receive less than 80% of the calculated dosage [11,12]. We addressed this issue by performing a sensitivity analysis that assumed regimen-specific dose reductions as published in the literature.…”

Cancer management and reimbursement aspects in Germany: an overview demonstrated by the case of colorectal cancer

“…The methods which are used by the Federal Statistical Office to calculate the health care expenditures are associated with some uncertainties (see methods of the cost of illness accounts of the Federal Statistical Office), but other German CRC cost studies are rare and the transferability of foreign calculations into the German setting is also not thoroughly recommendable [10][11][12]. There is a need for current, detailed CRC cost studies for the German setting to explore the economic burden of the disease as well as cost-driving parameters.…”