Rectal cancer EPICOST

The Economic Impact of Rectal Cancer: A Population-Based Study in Italy

To our knowledge, this paper is the first study to estimate, at a population level using micro-data, the economic burden of rectal cancer on the public health system in Italy. Estimation is based on a three-phase pattern of care - Initial, Continuing, Final- that considers the whole process of the disease from initial diagnosis to cure/death. Information at individual level comes from various healthcare and administrative databases.

Figure (a) Cost profile (or patient monthly average costs) due to hospitalization.Pool of CRs.

Cost estimates for the pool of 8 CRs (Milano, Friuli Venezia Giulia (VG), Veneto in the North; Firenze-Prato, Umbria, Latina in the Centre; Palermo, Napoli in the South) refer mainly to years 2010–2011. The X-axis measures the time in each phase of care: Initial  - indicate the 12 months of the initial phase; Continuing - the 12 months of the continuing phase; Final - the 12 months of the final phase. The Y-axis measures the monthly average cost per patient. 

Results show that average costs per patient have a U-shape: costs are higher in the first 2–3 months, when diagnostic tests and major surgeries are supplied, as well as in the end-of-life, when palliative care is supplied. Similar results are found elsewhere. In the initial phase of care, hospitalization costs are highest in the first two months after diagnosis.

Outpatient services costs are lower in the first month after diagnosis and then increase up to a maximum in the third month. Such a trend is coherent with the process of care: diagnostic tests and surgery are performed in hospital followed by chemotherapy and/or radiotherapy in an outpatient setting. A similar dual pattern is observed in the end-of-life phase of care: outpatient costs rise up in the first part and drop down in the last month before death, when hospitalization costs rise up. 

Hospitalization represents the main cost item (79% of total expenditure). Stage at diagnosis greatly influences costs of the initial phase of care, and cases diagnosed with advanced disease absorb 47% resources more than cases diagnosed with early disease. Age is another determinant of costs, since clinical approaches vary by age: more aggressive (and more expensive) treatments are better tolerated by younger patients, who have higher life expectancy when faced with aggressive treatments, in comparison with older patients, who generally have more co-morbidities.

The approach of this study allows policy makers to identify areas with different needs—among healthcare services, among phases of care, and among some patients’ characteristics, such as age and stage. Our model may support policy makers in predicting near-future cancer burden on the basis of different scenarios induced by specific interventions. For example, this study shows that early diagnosis of rectal cancer is a gain in the healthcare budget. Therefore, policies raising the spreading of and adherence to screening plans, above all when addressed to people living in the South of Italy, should be strongly encouraged. Presently, the diffusion and adherence of organized screening programs for colorectal cancer in Italy is very variable among regions.

The type of analysis proposed here can be extended to other countries with diverse healthcare managements and systems, as long as data on healthcare services and related costs at individual level are accessible. As an example, in the ongoing Innovative Partnership for Action Against Cancer (iPAAC) financed by the European Commission, the methodology has been proposed for application to other European countries, such as Belgium, Spain, Norway, and Poland (WP7 iPAAC).

Gigli A, Francisci S, Capodaglio G, Pierannunzio D, Mallone S, Tavilla A, et al. The economic impact of rectal cancer: A population-based study in Italy. Int J Environ Res Public Health 2021;18(2):1-17.


Written by Sandra Mallone CNaPPS - Istituto Superiore Sanità