title: Estimating colorectal cancer treatment costs: a pragmatic approach exemplified by health insurance data from Germany.
abstract: BACKGROUND
  The cost of colorectal cancer (CRC) treatment is a crucial parameter to inform cost-effectiveness analyses on CRC screening but it is not readily available and therefore often lacking. We aimed to elaborate and exemplify a pragmatic approach to estimate CRC treatment cost based on health insurance data from Germany.
  
  
  METHODS
  We included two groups of persons who were continuously health-insured between 2005-2010: A) Cases: Persons with a hospital discharge diagnosis of CRC (ICD C18-C20) between 2007-2010 and no such a diagnosis between 2005-2006 (to focus on incident CRC cases); B) Controls: Persons without a diagnosis of CRC during the observation period, matched to CRC cases by age and sex (matching factor: 1∶5). We considered in-patient, out-patient and drug costs and calculated incremental costs as the difference in means between cases and controls. We divided costs into three phases of care (initial, intermediate and end-of-life phase).
  
  
  RESULTS
  The initial, the intermediate and the end-of-life phase included 12,792, 5,280, and 3,779 CRC cases, respectively, and 63,960, 26,400, and 18,895 controls. The mean incremental costs--annualized for each phase--were €26,000, €2,300, and €51,700, respectively. The costs of the initial phase of care were higher for rectal than for colon cancer. Annualized stage-specific cost estimates ranged from €15,000 to €21,300 for early stages and from €29,800 to €35,000 for late stages.
  
  
  CONCLUSIONS
  This pragmatic and feasible approach provided plausible estimates of CRC treatment costs in Germany; being transferable to other settings, it may thus facilitate to weigh up potential savings in treatment costs against the resources required for CRC control programs in various countries.
authors.affiliation: Epidemiological Cancer Registry Baden-Wuerttemberg, German Cancer Research Center (DKFZ), Heidelberg, Germany.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Haug
authors.affiliation: WINEG - Scientific Institute of the Techniker Krankenkasse (TK) for Benefit and Efficiency in Health Care, Hamburg, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Engel
authors.affiliation: WINEG - Scientific Institute of the Techniker Krankenkasse (TK) for Benefit and Efficiency in Health Care, Hamburg, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Verheyen
authors.affiliation: WINEG - Scientific Institute of the Techniker Krankenkasse (TK) for Benefit and Efficiency in Health Care, Hamburg, Germany.
authors.forename: Roland
authors.initials: R
authors.lastname: Linder
mesh_terms: D015179:Colorectal Neoplasms / Q000628:therapy*; D003362:Cost-Benefit Analysis; D005858:Germany; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000191:economics*