Medical costs according to the stages of colorectal cancer: an analysis of health insurance claims in Hachioji, Japan

Abstract

Background Although the effect of the early detection of colorectal cancer (CRC) on medical costs needs to be clarified, there are few reports on the actual medical costs of CRC patients in Japan. We aimed to identify medical costs according to CRC stage, using health insurance claims. Methods This observational study included CRC patients who had received specific treatment for CRC, which was defined by the procedure code and the claim computer processing system code associated with the treatment of CRC. CRC patients who underwent endoscopic or radical surgical treatment were defined as the curable group and those with palliative treatment, including palliative chemotherapy, as the non-curable group. Total medical costs and medical costs of specific treatments for CRC for 3 years were measured using the claims held by Hachioji City from May 2014 to July 2019. Results This study included 442 patients in the curable group, including 267 patients who underwent endoscopic treatment, and 175 patients who underwent radical surgical treatment, and 161 patients in the non-curable group. The mean (standard deviation) total medical costs in the curable and non-curable groups were 2,130 (2,494) and 8,279 (5,600) thousand Japanese Yen (JPY), respectively. The mean (standard deviation) medical costs for the specific treatment of CRC in the curable and non-curable groups were 408 (352) and 3,685 (3,479) thousand JPY, respectively. Conclusions We clarified the actual medical costs of CRC in curable and non-curable groups. These results suggest the effect of early detection of CRC in reducing medical costs.

Direct medical costs of young-onset colorectal cancer: a worldwide systematic review

“…Studies varied in countries where they were conducted, which included the USA [ 11 , 17 , 19 ], England [ 15 , 18 ], France [ 16 ], China [ 12 , 20 ], Korea [ 10 ], Vietnam [ 13 ], Italy [ 14 ], Australia [ 21 ], Canada [ 22 ] and Japan [ 23 ]. Five studies utilized claims data from a health insurance database [ 10 , 16 , 17 , 19 , 23 ], three used data abstracted from hospital medical records [ 12 , 13 , 20 ], four used administrative health data [ 14 , 15 , 18 , 22 ], one study used data from a nationally representative medical expenditure survey [ 11 ], lastly another study linked self-reported survey data with an administrative health database [ 21 ]. It must also be noted that studies which relied on either survey data [ 11 , 21 ] or hospital medical records [ 12 , 13 , 20 ], may omit data from non-responders and those receiving care from other hospital(s), respectively, which may impact the generalizability of their cost estimates.…”

“…Specifically, studies by Gigli and Taplin et al, focused on rectal [ 14 ] and colon [ 17 ] cancer, respectively, while Goldsbury et al, stratified cost estimates by age and cancer site (i.e., colon and rectum) [ 21 ]. CRC was identified using International Disease Classification codes in 10 studies [ 10 , 13 , 14 , 16 – 19 , 21 – 23 ], two studies used hospital medical records [ 15 , 20 ], and two studies relied on self-reported diagnosis [ 11 , 12 ]. With respect to cancer stage at diagnosis, 10 studies included CRC patients with stage I to IV disease [ 12 – 18 , 20 , 22 , 23 ], two studies did not report cancer stage [ 10 , 11 ], one study included CRC patients with a stage IV de novo (no prior CRC diagnosis) diagnosis or a recurrent (previously diagnosed with stage I-III CRC) cancer diagnosis [ 19 ], and one study reported cancer severity by the extent of cancer metastasis (i.e., localized, regional, distant metastases) [ 21 ].…”

“…CRC was identified using International Disease Classification codes in 10 studies [ 10 , 13 , 14 , 16 – 19 , 21 – 23 ], two studies used hospital medical records [ 15 , 20 ], and two studies relied on self-reported diagnosis [ 11 , 12 ]. With respect to cancer stage at diagnosis, 10 studies included CRC patients with stage I to IV disease [ 12 – 18 , 20 , 22 , 23 ], two studies did not report cancer stage [ 10 , 11 ], one study included CRC patients with a stage IV de novo (no prior CRC diagnosis) diagnosis or a recurrent (previously diagnosed with stage I-III CRC) cancer diagnosis [ 19 ], and one study reported cancer severity by the extent of cancer metastasis (i.e., localized, regional, distant metastases) [ 21 ]. Overall, nine studies [ 12 , 14 , 15 , 18 – 23 ] scored well against the modified CHEERS checklist with scores ≥ 14 and thus being classified as studies of ‘good quality’ (Table S 4 ).…”

“…With respect to cancer stage at diagnosis, 10 studies included CRC patients with stage I to IV disease [ 12 – 18 , 20 , 22 , 23 ], two studies did not report cancer stage [ 10 , 11 ], one study included CRC patients with a stage IV de novo (no prior CRC diagnosis) diagnosis or a recurrent (previously diagnosed with stage I-III CRC) cancer diagnosis [ 19 ], and one study reported cancer severity by the extent of cancer metastasis (i.e., localized, regional, distant metastases) [ 21 ]. Overall, nine studies [ 12 , 14 , 15 , 18 – 23 ] scored well against the modified CHEERS checklist with scores ≥ 14 and thus being classified as studies of ‘good quality’ (Table S 4 ). Items not consistently reported by studies that scored below 14 points on the modified CHEERS checklist [ 10 , 11 , 13 , 16 , 17 ] included, specification of their study perspective (i.e., authors failed to specify their costing perspective), detailed methods for how they estimated resource utilization and costs components, the price date and conversion rate used, and provision of study parameters (i.e., values, references and ranges for input values used to estimate cost).…”

“…Table 2 highlights aspects of the costing methodology employed by each included study. Given our particular interest in those with yCRC, we synthesized age cut-offs applied, which varied from < 50 years in five studies [ 10 , 13 , 14 , 22 , 23 ], < 55 years in three studies [ 12 , 20 , 21 ], and < 65 years in six studies [ 11 , 15 – 19 ]. While all studies reported costs of CRC treatment (i.e., chemotherapy and radiation therapy) and in-patient visits (i.e., hospitalization), only seven of the included studies considered costs related to ambulatory care, including both outpatient medical visits and prescription medications [ 10 – 12 , 14 , 16 , 17 , 23 ].…”