Treatment Costs of Colorectal Cancer by Sex and Age: Population-Based Study on Health Insurance Data from Germany

Simple Summary Screening for colorectal cancer (CRC) has considerably contributed to declining CRC incidence and mortality rates in Germany over the last two decades. However, evidence on the cost-effectiveness of this public health remains scarce, mostly due to the lack of detailed sex- and age-specific estimates on CRC treatment costs over time. Using a large research database on insurance claims data, we analyzed CRC-related inpatient, outpatient as well as medication costs up to five years after diagnosis and prior to death. Our findings show that costs in the terminal phase of care were consistently on a high level even several years preceding death, mostly driven by high inpatient and medication costs, and substantially higher as compared to the initial phase of care. As well, we observed a consistent pattern of higher costs in men versus women, most markedly in the first year of diagnosis and the final year of life, and strongly varying costs by age. Our findings could be highly useful in informing cost-effectiveness analyses e.g., to further optimize strategies to screen for CRC. Objective: Evidence on the cost-effectiveness of screening for colorectal cancer (CRC) in the German general population remains scarce as key input parameters, the costs to treat CRC, are largely unknown. Here, we provide detailed estimates on CRC treatment costs over time. Methods: Using insurance claims data from the Vilua healthcare research database, we included subjects with newly diagnosed CRC and subjects who died of CRC between 2012 and 2016. We assessed annualized CRC-related inpatient, outpatient and medication costs for up to five years after first diagnosis and prior to death, stratified by sex and age. Findings: We identified 1748 and 1117 subjects with follow-up data for at least 1 year after diagnosis and prior to death, respectively. In those newly diagnosed, average costs were highest in the first year after diagnosis (men, EUR 16,375-16,450; women, EUR 10,071-13,250) and dropped steeply in the following years, with no consistent pattern of differences with respect to age. Costs prior to death were substantially higher as compared to the initial phase of care and consistently on a high level even several years before death, peaking in the final year of life, with strong differences by sex and age (men vs. women, <70 years, EUR 34,351 vs. EUR 31,417; >= 70 years, EUR 14,463 vs. EUR 9930). Conclusion: Once clinically manifest, CRC causes substantial treatment costs over time, particularly in the palliative care setting. Strong differences in treatment costs by sex and age warrant further investigation.