The dynamics of colorectal cancer management in 17 countries

Abstract

This paper discusses the current care management arrangements for colorectal cancer (CRC) in 16 OECD countries plus the Russian Federation by analysing data sources, the uptake of screening and surveillance, the available capacity in endoscopy services, the treatment pathways in medical treatment, as well as the type and availability of pharmaceutical care. The paper highlights significant variations in practice across the 17 countries. Common themes emerge from each of these practices and standards in terms of political interest in policies and awareness of CRC (both of which need to be enhanced), affordability (in terms of scarcity of resources in some countries and out-of-pocket payments for parts of the overall treatment process), access (in terms of the significant variation that has been observed within and across countries with regard to diagnostics, treatment and certain pharmaceuticals) and quality of CRC services (which may arise due to variations in treatment and pharmaceutical guidelines as well as minimal monitoring). When considering policy options for the future, it is important to, first, improve data collection both within as well as across countries through international co-operation; second, it is critical to have greater national and international support for cancer screening activities proven to be effective and cost-effective; third, endoscopy capacity in individual countries needs to be improved, also allowing more choice to ensure timely diagnosis, regardless of screening activities; fourth, public and political awareness needs to be enhanced as it is the key to improving CRC outcomes; fifth, where appropriate, to give consideration to the principles of equity, human dignity and disease severity, among others, when deciding on the uptake of new (targeted) treatments, rather than base decisions solely on cost-effectiveness criteria; and sixth, to firm up national guidelines including screening, diagnosis, treatment, pharmaceutical treatments and surveillance, with a view to enhancing their timeliness, evidence-base and free access to all.

Cost of care for colorectal cancer in Ireland: a health care payer perspective

“…It is difficult to compare overall costs between studies because of differences in cost perspective, type of costs included, length of follow-up and whether disease recurrence and/or follow-up surveillance was included. Furthermore, diagnostic and treatment pathways differ between health care settings and have changed over time [9]. As an illustration of the effect of the latter, a US study (2006) suggested that lifetime costs of treatment of metastatic colorectal cancer were close to $100,000 [51], which reflects at least a doubling of the costs compared with studies performed during the 1990s [2].…”

“…As highlighted previously in this journal, there is often poor-quality data on colorectal cancer expenditure [9]. As well as being a key component of the overall economic burden associated with colorectal cancer morbidity and mortality, such data are needed to (a) understand the magnitude of financial and productive resources that must be mobilised to effectively care for colorectal cancer patients and (b) as inputs to cost-effectiveness analyses of cancer prevention, screening and treatment programs.…”

“…Even though cancer causes a large economic burden, only a few countries have actually estimated how large these costs really are. A previous supplement of this journal, which focused on colorectal cancer and its burden in a number of OECD countries, highlights the need for detailed countryspecific colorectal cancer costing studies [8,9].…”

miR-429 Identified by Dynamic Transcriptome Analysis Is a New Candidate Biomarker for Colorectal Cancer Prognosis

“…For decades, colonoscopy has been the primary screening method, and surgical resection has been the ultimate therapeutic treatment. However, early detection and late-stage treatment remain major challenges for those who suffer from this disease (Kahi et al, 2008;Kanavos and Schurer, 2010). Colorectal carcinogenesis is a complicated process with polygenic factors (Weitz et al, 2005).…”

Can we Continue to Afford Access to Cancer Treatment?

“…1,47 Evidence shows that the relationship between a particular nation's spend on cancer care and outcomes is weak. For example, in some European countries, the cost of colorectal cancer varies almost 20-fold, with no clear evidence of a survival benefit (Figure 2), 48 while others report highly variable outcomes for the same per-patient spend.…”