R (2014) Estimating colorectal cancer treatment costs: a pragmatic approach exemplified by health insurance data from Germany. PLoS One 9:e88407

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 J26,000, J2,300, and J51,700, respectively. The costs of the initial phase of care were higher for rectal than for colon cancer. Annualized stage-specific cost estimates ranged from J15,000 to J21,300 for early stages and from J29,800 to J35,000 for late stages. Conclusion: This pragmatic and feasible approach provided plausible estimates of CRC treatment costs in Germany; bein