title: The cost of anal cancer in England: retrospective hospital data analysis and Markov model.
abstract: BACKGROUND
  Anal cancer requires a multidisciplinary approach to treatment with often complex interventions. Little is known regarding the associated costs and resource use.
  
  
  METHODS
  Patient records were extracted from a national hospital database to estimate the number of patients treated for anal cancer in England. Identified resource use was linked to published UK cost estimates to quantify the reimbursement of treatment through the Payment by Results system. A mathematical model was developed simultaneously to validate findings and to calculate the average 10-year cost of treating a squamous cell anal carcinoma case from diagnosis. The model utilised data from the Association of Coloproctology of Great Britain and Ireland's anal cancer position statement.
  
  
  RESULTS
  On average, 1,564 patients were admitted to hospital and 389 attended an outpatient facility per year. The average annual cost per inpatient and outpatient ranged from £4,562-£5,230 and £1,146-£1,335, respectively. Based on the model estimates, the inflated cost per case was between £16,470-£16,652. Results were most sensitive to the mode of admission for primary treatment and the costs of staging/diagnosis (inflated range: £14,309-£23,264).
  
  
  CONCLUSIONS
  Despite limitations in the available data, these results indicate that the cost of treating anal cancer is significant. Further observational work is required in order to verify these findings.
authors.forename: Sam T
authors.initials: ST
authors.lastname: Keeping
authors.affiliation: Pharmerit Ltd, Enterprise House, Innovation Way, York YO10 5NQ, UK. mtempest@pharmerit.com.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Tempest
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Stephens
authors.forename: Stuart M
authors.initials: SM
authors.lastname: Carroll
authors.forename: Karen P
authors.initials: KP
authors.lastname: Nugent
authors.forename: Sarah T
authors.initials: ST
authors.lastname: O'Dwyer
mesh_terms: D000368:Aged; D001005:Anus Neoplasms / Q000191:economics*; D002294:Carcinoma, Squamous Cell / Q000191:economics*; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D004739:England; D005260:Female; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D012189:Retrospective Studies; D013222:State Medicine