Time definition
Perspective
No of patients
Costs/charges included
Cost/charges as reported in original studya
Costs/charges in 2014 U.S. $
Lifetime and treatment–phase specific costs
Lang et al. [12]
Initial: Up to 1 year after diagnosis and before the last year of life. Patients were only included if lived at least 13 months after diagnosis
Medicare and private insurance payments (cost to 3rd party payers) as well as patient co-pays and deductibles (cost to the patient) in 2006 U.S. $; Future costs discounted at 3 % per year
15,582
Charges as a proxy for direct costs of inpatient hospital (including prescription drugs and chemotherapy) and skilled nursing facility stays, outpatient hospital services (including chemotherapy), physician and laboratory services, home health, and hospice care
Initial: $32,683
$42,784
Continuing: $5,254
$6,878
Terminal: $14,878
$19,476
Excess lifetime costs:
$26,544
$34,748
Continuing: Period between first and last year of life if lived at least 25 months
Terminal: Final year of life or period from diagnosis to death if lived less than 13 months
Advanced cancer care costs
Neymark and Adriaenssen [15]
Date of diagnosis to death or last known visit Median follow-up was 530 days
Cost to the national health insurance system in Italy, England, France, Germany, and Belgium in 1998 Belgian francs, using unit prices from Belgium for all five countries
200
Direct costs of hospital stays, outpatient visits, home health visits, physician and laboratory services, radiological examinations, and chemotherapy
Stage III: 881,778 BF
$28,552
$51,892
Stage IV: 716,564 BF
$19,139
$34,784
Surgery with or without PRT
van den Brink et al [13]
Date of random assignment to TME with or without preoperative radiotherapy until recurrence or death (median follow-up = 38 months; range = 13–68 months)
Cost to society calculated using Markov modelling in 2002 U.S. $, discounted at 3 % per year
1,861
Direct costs of primary treatment, continuing care, and recurrence treatment including inpatient and outpatient services, nursing home care, diagnostic procedures, chemotherapy, and radiotherapy. Travel and out-of-pocket costs are included as are indirect costs associated with lost productivity, informal care and time
PRT + TME:
$115,000
$177,130
TME: $105,200
$162,036
Cost per QALY:
$25,100
$38,661
van den Brink et al. [16]
12 month period after total mesorectal excision
Cost to the patient and costs to the Dutch National Health Authority in 2012 €
179
Direct medical costs of inpatient and outpatient services, home health services, medications, and stoma care products
Provider–reported cost:
3,730 € or $3,486
$3,702
Patient–reported cost:
3,300 € or $3,084
$3,275
Dahlberg et al. [14]
Date of random assignment to AP/APR with or without PRT until death or 8 years
Cost to society (primarily the national health insurance system) in Sweden in 2001 U.S. $, discounted at 3 % per year
27 PRT + AP; 21 PRT + APR; 18 AR only; 30 APR only
Direct costs of inpatient and outpatient services as well as care for complications and recurrence. Hotel and travel expenses for PRT were also included. Indirect costs, such as lost productivity, were excluded
PRT + AP/APR:
$35,268
$56,875
AP/APR: $30,080
$48,509
Cost per LY gained:
$3,654
$5,893
TEM
Maslekar et al. [17]
Date of TEM or AR to date of hospital discharge
Cost to the national health insurance system in the UK in 2006 £
124 cases; 52 controls
Direct costs of inpatient surgery, intensive care unit and inpatient bed days, and cost of disposable items. Staff, diagnostic testing, and medication costs were excluded because assumed equivalent between the two groups. Estimated equipment costs of £40,000 were also excluded
AR without ileostomy:
£4,135; $7,643
$10,005
AR with ileostomy:
£6,323; $11,688
$15,300
TEM: £ 567; $1,048
$1,372
11.5 procedures to recover capital costs
Farmer et al. [18]
Date of hospital admission for TEM or AR to a median follow-up of 33 months (range 20–48 months)
Cost to the national health insurance system in Australia in 2002 Australian $. Unclear if any costs are borne by the patient
36 benign; 14 malignant
Direct costs of inpatient bed days and disposable equipment, and physician (medical) fees. Equipment costs not provided or included
TEM: Aust $2,400
U.S.$1,348
$2,076
AR: Aust $7,900
U.S. $4,438
$6,836
Hompes et al. [19]
Date of hospital admission for glove TEM to a median follow-up of 5.7 months (range: 2.7–9.4 months)
Cost to the national health insurance system in the U.K. assumed in £. No detail provided. Assume 2011 £
8 benign; 6 malignant
Direct cost of port only included. Costs of complications or conversion to traditional TEM are not included.
TEM with reusuable trocars: £31; $50
$55
TEM with disposable ports: £82.50; $132
$145
Stomas and AL
Kang et al. [20]
Date of hospital admission for AR to hospital discharge
Charges primarily to third party payers using 2006–2009 data in $. Unclear how much of the cost was born by the patient. 2009 $ assumed
72,055
Total charges associated with the AR admission. Anastomotic breakdown after discharge excluded from analysis.
AR without
$60,238
AL:$51,413
$109,093
AR with AL: $93,110
Koperna [21]
Date of LAR through less than 1 year of follow-up. Median follow-up not provided
Cost to the hospital provider in 2000 €
19 LAR with stoma; 48 LAR without stoma or AL; 3 LAR no stoma, with AL
Direct costs per bed day of inpatient and ICU care were comprised of cost of laboratory services, diagnostic imaging, endoscopy, supplies, medications, operating room costs, and costs of devices used during surgery. Indirect costs of lost productivity were not included
LAR no stoma or AL:
€8,400; $7,850
$13,242
LAR with AL:
€13,985; $13,070
$22,047
LAR no stoma and AL:
€42,250; $39,486
$66,606
Open versus laparoscopic surgery
Franks et al. [22]
Date of surgery until 3 months after surgery
Cost to the national health insurance system in the UK in £ using data from a variety of years. 2002 £ assumed
222 LAP; 112 Open
Direct costs per day of inpatient care, ICU care, operating room costs including staff time and supplies, chemotherapy and radiotherapy costs, and complication costs including related readmission costs. Indirect costs associated with lost productivity were also included
Direct
LAP: £7,148; $10,963
$16,886
Open: £6,596; $10,117
$15,583
Indirect
LAP: £1,112; $1,706
$2,628
Open: £1,224; $1,827
$2,814
Total
LAP: £8,260; $12,669
$19,514
Open: £7,820; $11,994
$18,474
Date of surgery until a median of 54.2 months after surgery
Cost to the hospital in $. 2006 $ assumed.
83 LAP; 85 Open
Direct costs of surgery (including per hour operating room costs and surgical instruments), routine surgical care per day, complications (including medical, laboratory, technical, and diagnostic services, surgical and therapeutic interventions, prolonged length of stay, associated outpatient visits
Excess costs for LAP compared to Open:
OR: $1,748
$2,288
Surgical care: −$648
−$848
Complications: −$749
−$980
Total: $351
$460
Park et al. [25]
Day of admission until date of discharge
Cost to the national health insurance system in Korea and cost to the patient in $ as components of total charges. The early learning phase was May 2003-July 2004 and the post-learning phase was August 2004–January 2006. Though unclear, costs are assumed to be inflated to at least 2005 levels and reported in U.S. dollars
116 LAP; 81 Open
Direct costs of operating room (including equipment, labor and disposable and reusable supplies) as well as anesthesia, laboratory, radiology, nursing, medications, and admission services. Hospital profit and specialist fees also included. Chemotherapy and radiotherapy costs were excluded as well as indirect costs
Learning phase total charges
LAP: $8,088
$11,011
Open: $6,192
$8,430
Post-learning phase total charges
LAP: $7,983
$10,868
Open: $7,045
$9,591
Leung et al. [26]
Date of surgery until date of discharge
Cost to the hospital in US $. 2003 $ assumed
203 LAP; 200 Open
Direct costs for hospital inpatient services and disposables, and per hour operating room costs based on “market rates”
LAP: $9,297
$13,769
Open: $7,148
$10,586
Son et al. [27]
Date of surgery until 3 months after surgery
Cost to the national health insurance system and cost to the patient in 2009 $ based on billed charges
130 LAP; 125 Open
Charges as a proxy for the cost of hospitalization for surgery and readmission for complications (including operation, anesthesia, nursing, laboratory, medications, radiologic tests, disposables). Specialist fees and indirect costs were excluded
Total charges
LAP: $7,467
$8,749
Open: $5.667
$6,640
Patient co-payment:
LAP: $1,602
$1,877
Open: $899
$1,053
Fujii et al. [28]
Rectal transection procedure, from start to finish
Cost in Japanese yen. 2008 yen assumed
107 stapling; 28 Y-hood
Direct cost of the automatic stapling unit and Y-hood
Stapling (2–4 times):
92,505 yen
$3,486
$4,215
Y-hood: 53,107 yen
$3,084
$3,729
Lifetime and Treatment-Phase Specific Costs
The article by Lang et al. [12] is a particularly well written article that fills a void in the recent rectal cancer literature. While lifetime treatment costs for colorectal cancer patients were reported as early as 1989 by Baker et al. and more recently by Etzioni [29] among others, it was not until the early to mid-1990s [30, 31] that attempts were made to separately measure such costs for rectal cancer patients. Data from these pre-2000 articles, though still referenced, are severely out of date. It is important to separately report costs for patients diagnosed with rectal cancer as costs are generally higher for these patients when compared to patients diagnosed with colon cancer as this chapter will demonstrate.
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