Francisci S., Gigli A., Guzzinati S., Busco S., Pierannunzio D., Mallone S. 

Riunione GRELL

Albi (Francia),  4-6 maggio 2016



To reconstruct cancer pathway and cost-related dynamic according to 3 phases of care: initial, continuing and final.

The profiles of cancer-related costs are built using administrative data (hospital admissions, outpatients and pharmaceutical data) linked at individual level with cancer registry data: prevalent cases are decomposed into 3 phases of care and corresponding costs are computed. Cancer sites considered are colon, rectum and breast; the Italian registries participating in the study are located in 7 regions, spanning from North to South.

Preliminary results for colorectal cancer applied to a cohort of patients from two cancer registries (Veneto and Tuscany) show cost profiles with very high costs during the first months of the initial phase, then declining until reaching a plateau during the continuing phase and then increasing again during the final phase of life. There is a trend in costs by stage at diagnosis in the initial phase: more advanced stages correspond to higher average costs, in all age classes and particularly among the youngest. This result is consistent with the clinical guidelines which suggest different treatment strategies according to the tumour stage. Age is also related to costs: younger patients have higher costs in all phases of the disease.

The phase-of-care approach allows the estimation of patterns of care and costs at a given date, taking into account the survivors' distribution and their care needs during lifespan. The study confirms that stage at diagnosis has an influence on the therapeutic strategy and related costs. The results confirm the importance of primary prevention and early detection of cancer in a public health perspective, not only in the improvement of patients survival and but also in the economic sustainability of healthcare. The methodology can also be used to compare patterns of care in different countries and settings.