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Estimating the direct costs of bowel cancer services provided by the National Health Service in England

Published online by Cambridge University Press:  13 October 2010

Matthew W. Bending ,
Paul Trueman ,
Karin V. Lowson ,
Hazel Pilgrim ,
Paul Tappenden ,
Jim Chilcott  and
Janine Tappenden
Matthew W. Bending
Affiliation:
University of York
Paul Trueman
Affiliation:
Brunel University
Karin V. Lowson
Affiliation:
University of York
Hazel Pilgrim
Affiliation:
University of Sheffield
Paul Tappenden
Affiliation:
University of Sheffield
Jim Chilcott
Affiliation:
University of Sheffield
Janine Tappenden
Affiliation:
University of Sheffield
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Abstract

Objectives: Bowel cancer is the second most common cancer in England and Wales, accounting for approximately 13,000 deaths per year. Economic evaluations and national guidance have been produced for individual treatments for bowel cancer. However, it has been suggested that Primary Care Trusts develop program budgeting or equivalent methodology demonstrating a whole system approach to investment and disinvestment. The objective of this study was to provide a baseline framework for considering a whole system approach to estimate the direct costs of bowel cancer services provided by the National Health Service (NHS) in England.

Methods: A treatment pathway, developed in 2005, was used to construct a service pathway model to estimate the direct cost of bowel cancer services in England.

Results: The service pathway model estimated the direct cost of bowel cancer services to the NHS to be in excess of £1 billion in 2005. Thirty-five percent of the cost is attributable to the screening and testing of patients with suspected bowel cancer, subsequently diagnosed as cancer-free.

Conclusions: This study is believed to be the most comprehensive attempt to identify the direct cost of managing bowel cancer services in England. The approach adopted could be useful to assist local decision makers in identifying those aspects of the pathway that are most uncertain in terms of their cost-effectiveness and as a basis to explore the implications of re-allocated resources. Research recommendations include the need for detailed costs on surgical procedures, high-risk patients and the utilization of the methods used in this study across other cancers.

Keywords

Colorectal neoplasmsCost of illnessModelsEconomic
Type
ASSESSMENTS
Information
International Journal of Technology Assessment in Health Care , Volume 26 , Issue 4 , October 2010 , pp. 362 - 369
Copyright
Copyright © Cambridge University Press 2010

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References

REFERENCES

1. Andre, T, Boni, C, Mounedji-Boudiaf, L, et al. Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer: MOSAIC trial. N Engl J Med. 2004;350:2343–2351.CrossRefGoogle Scholar
2. Briggs, A, Sculpher, M, Claxton, K. Decision modelling for health economic evaluation. Oxford: Oxford University Press; 2006.CrossRefGoogle Scholar
3. Ciccolallo, L, Capocaccia, R, Coleman, M, et al. Survival differences between European and US patients with colorectal cancer: Role of stage at diagnosis and surgery. Gut. 2005;54:268–273.CrossRefGoogle Scholar
4. Coleman, M, Gatta, G, Verdecchia, A, et al. EUROCARE-3 summary: Cancer survival in Europe at the end of the 20th century. Ann Oncol. 2003;14 (Suppl 5):128–149.CrossRefGoogle ScholarPubMed
5. Decisioneering. Crystall ball. Denver, CO: Decisioneering; 2000.Google Scholar
6. Department of Health. World class commissioning. Commissioning assurance handbook. London: Department of Health; 2008.Google Scholar
7. Department of Health. Hospital episode statistics (2003/2004). 2005. http://www.hesonline.nhs.uk/Ease/servlet/ContentServer?siteID=1937&categoryID=245 (accessed January 18, 2010).Google Scholar
8. Department of Health. NHS reference costs 2005. London: Department of Health; 2006. Report No: 4664.Google Scholar
9. Department of Health. Cancer Reform Strategy. London: Department of Health; 2007. Report No: 9092.Google Scholar
10. Forman, D, Stockton, D, Moller, H, et al. Cancer prevalence in the UK: Results from the EUROPREVAL study. Ann Oncol. 2003;14:648–654.CrossRefGoogle ScholarPubMed
11. Garthwaite, P, Chilcott, J, Jenkinson, D, Tappenden, P. Use of expert knowledge in evaluating costs and benefits of alternative service provisions: A case study. Int J Technol Assess Health Care. 2008;24:350–357.CrossRefGoogle ScholarPubMed
12. Hind, D, Tappenden, P, Tumur, I, et al. The use of irinotecan, oxaliplatin and raltitrexed for the treatment of advanced colorectal cancer: Systematic review and economic evaluation. Health Technol Assess. 2008;12:iii–ix, xi–162.CrossRefGoogle ScholarPubMed
13. Mawdsley, S, Glynne-Jones, R, Grainger, J, et al. Can histopathologic assessment of circumferential margin after preoperative pelvic chemoradiotherapy for T3-T4 rectal cancer predict for 3-year disease-free survival? Int J Radiat Oncol Bio Phys. 2005;63:745–752.CrossRefGoogle ScholarPubMed
14. Microsoft. Excel 2003. Redmond, WA: Microsoft Corporation; 2003.Google Scholar
15. Netten, A, Curtis, L. Unit costs of health and social care 2005. Canterbury, Kent: Personal Social Services Research Unit, University of Kent at Canterbury; 2005.Google Scholar
16. O'Hagan, A, Buck, C, Daneshkhah, A, et al. Uncertain judgements: Eliciting experts’ probabilities. Chichester: John Wiley & Sons; 2006.CrossRefGoogle Scholar
17. Office for National Statistics. Cancer statistics registrations: Registrations of cancer diagnosed in 2003, England. London: Office for National Statistics; 2003. http://www.statistics.gov.uk/downloads/theme_health/MB1_34/MB1_34.pdf.Google Scholar
18. Office for National Statistics. Cancer statistics registrations. London: Office for National Statistics; 2006 http://www.statistics.gov.uk/downloads/theme_health/MB1-37/MB1_37_2006.pdf (accessed January 18, 2010).Google Scholar
19. Office for National Statistics. Mortality statistics: Review of the Registrar General on deaths by cause, sex, and age, in England and Wales, 2007. London: Office for National Statistics; 2007. http://www.statistics.gov.uk/downloads/theme_health/DR2007/DR_07_2007.pdf (accessed January 18, 2010).Google Scholar
20. Pandor, A, Eggington, S, Paisley, S, et al. The clinical and cost-effectiveness of oxaliplatin and capecitabine for the adjuvant treatment of colon cancer: Systematic review and economic evaluation. Health Technol Assess. 2006;10:iii–iv, xi–xiv, 1–185.CrossRefGoogle ScholarPubMed
21. Pilgrim, H, Tappenden, P, Chilcott, J, et al. The costs and benefits of bowel cancer service developments using discrete event simulation. J Oper Res Soc. 2009;60:1305–1314.CrossRefGoogle Scholar
22. Ruta, D, Mitton, C, Bate, A, Donaldson, C. Programme budgeting and marginal analysis: Bridging the divide between doctors and managers. Br Med J. 2005;330:1501–1503.CrossRefGoogle ScholarPubMed
23. Sebag-Montefiore, D, Steele, R, Quirke, P, et al. Routine short course pre-op radiotherapy or selective post-op chemoradiotherapy for resectable rectal cancer? Preliminary results of the MRC CR07 randomised trial. ASCO Annual Meeting 2006.CrossRefGoogle Scholar
24. Seymour, MT. Optimizing the use and sequencing of fluorouracil, irinotecan and oxaliplatin in advanced colorectal cancer (ACRC): The UK MRC FOCUS (CR08) Trial. European Society of Medical Oncology Conference 2004.Google Scholar
25. Tappenden, P, Chilcott, J, Eggington, S, et al. Option appraisal of population-based colorectal cancer screening in England. Gut. 2007;56:677–684.CrossRefGoogle ScholarPubMed
26. Tappenden, P, Jones, R, Paisley, S, Carroll, C. Systematic review and economic evaluation of bevacizumab and cetuximab for the treatment of metastatic colorectal cancer. Health Technol Assess. 2007;11:1–128, iii–iv.CrossRefGoogle ScholarPubMed
27. The Clinical Outcomes of Surgical Therapy Study Group, . A comparison of laparoscopically assisted and open colectomy for colon cancer: COST trial. N Engl J Med. 2004;350:2050–2059.Google Scholar
28. Trueman, P, Lowson, K, Bending, M, et al. Bowel cancer services: Costs and benefits literature review. Report to the Department of Health. London: Department of Health; 2007.Google Scholar
29. Twelves, C, Wong, A, Nowacki, M, et al. Capecitabine as adjuvant treatment for stage III colon cancer: X-ACT trial. N Engl J Med. 2005;352:2696–2704.CrossRefGoogle Scholar
30. Ward, S, Kaltenthaler, E, Cowan, J, Brewer, N. Clinical and cost-effectiveness of capecitabine and tegafur with uracil for the treatment of metastatic colorectal cancer: Systematic review and economic evaluation. Health Technol Assess. 2003;7:1–93.CrossRefGoogle ScholarPubMed
31. Yabroff, K, Mariotto, A, Feuer, E, Brown, M. Projections of the costs associated with colorectal cancer care in the United States, 2000-2020. Health Econ. 2008;17:947–959.CrossRefGoogle ScholarPubMed
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