Background
Introduction
In most developed Countries, the economic and social impact of cancers on healthcare system continues to increase.
This is due to several reasons: the expansion of aged population, the improving diagnostic capacity and the availability of targeted and efficient cancer drugs with reduced side effects will increase both incidence and prevalence of cancers.
Measuring and projecting the economic burden associated with cancer and identifying effective policies for minimizing its impact are important issues for health care policy makers and health-care system.
Project history
In 2009, a pilot study on colorectal cancers has been implemented for the first time in two Italian areas covered by cancer registration (Tuscany and Veneto) with the aim to estimate burden and corresponding health care costs: incidence and follow-up cancer registry (CR) data were linked at individual level with costs of treatments and procedures from hospital discharge database, thus allowing the estimation and qualification of cancer-related costs in different phases of the illness. Aim of the study was to estimate the total amount of public health care resources used for cancer patients and their distribution according to a three disease-phase pathway with initial (one year following diagnosis), continuing (between initial and final), and final phases of care (the last year of life). Main results of the study (Francisci et al., 2013) are:
cost distribution per patients curve follows a U-shape with higher initial and final cost and lower cost in the continuing phase;
there is an association between patterns of care/costs and patients characteristics such as stage and age at diagnosis.
The diversity in health-care delivery, expenditures and cancer outcomes suggests that comparative studies between health-care systems and/or countries might inform evaluation, development, or modification of policies related to cancer screening, treatment, and programs of care delivery (eg, hospice care for cancer patients at the end of life). For these reasons a similar experiences in the US were based on the National Cancer Surveillance and End Results (Surveillance, Epidemiology, and End Results) program linked to Medicare claims with the aim to estimate and project cancer burden and costs over time. The results of this comparative study have been published in the monograph Comparing Cancer Care and Economic Outcomes Across Health Systems: Challenges and Opportunities (2013, JNCI) by the National Cancer Institute (NIH), in collaboration with the National center for disease prevention and health promotion (CNaPPS), Istituto Superiore di Sanità, the Institute for Research on Population and Social Policies (IRPPS) - National Research Council (CNR), and University of Roma 'Tor Vergata' - Centre for Economic and International Studies. In spite of structural differences between United States and Italy in health-care organization and delivery as well as in data collection, patterns of care and timing of care in the years after diagnosis are generally similar among patients within stage of disease at diagnosis.