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Systematic review of economic evidence for the detection, diagnosis, treatment, and follow-up of colorectal cancer in the United Kingdom

Published online by Cambridge University Press:  22 October 2009

Paul Tappenden ,
Jim Chilcott ,
Alan Brennan  and
Hazel Pilgrim
Paul Tappenden
Affiliation:
University of Sheffield
Jim Chilcott
Affiliation:
University of Sheffield
Alan Brennan
Affiliation:
University of Sheffield
Hazel Pilgrim
Affiliation:
University of Sheffield
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Abstract

Objectives: The aim of this study was to examine the availability and consistency of economic evidence for the detection, diagnosis, treatment, and follow-up of colorectal cancer.

Methods: A systematic review of UK economic evaluations of colorectal cancer interventions was undertaken. Searches were undertaken across ten electronic databases. Studies were critically appraised through reference to a conceptual model of UK colorectal cancer services.

Results: Forty-seven studies met the inclusion criteria. There is a substantial economic evidence base surrounding population-level colorectal screening, surgical procedures, and cytotoxic therapies for the adjuvant and palliative treatment of colorectal cancer. There is limited evidence concerning the diagnosis of suspected colorectal cancer, curative treatments for metastatic disease and follow-up regimens for nonmetastatic disease. No studies were identified relating to the economics of radiotherapy, surveillance of increased-risk groups, end-of-life care, or the management of hereditary colorectal cancer. Where evidence is available, studies are subject to important differences concerning treatment options, decision criteria, and incongruent assumptions concerning the disease and its management.

Conclusions: Across many aspects of the colorectal cancer service, current practice appears to have emerged without the consideration or support of economic evidence. There is a need to develop a common understanding how colorectal cancer models should be structured and implemented.

Keywords

Colorectal neoplasmsReview literatureEconomicsCost-benefit analysis
Type
General Essays
Information
International Journal of Technology Assessment in Health Care , Volume 25 , Issue 4 , October 2009 , pp. 470 - 478
Copyright
Copyright © Cambridge University Press 2009

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References

REFERENCES

1. Aballea, S, Boler, A, Craig, A, Wasan, H. An economic evaluation of oxaliplatin for the adjuvant treatment of colon cancer in the United Kingdom. Eur J Cancer. 2007;43:1687–1693.CrossRefGoogle ScholarPubMed
2. Barber, MD, Abraham, A, Brydon, WG, et al. Assessment of faecal occult blood loss by qualitative and quantitative methods. J R Coll Surg Edinb. 2002;47:491–494.Google Scholar
3. Beard, SM, Holmes, M, Price, C, Majeed, AW. Hepatic resection for colorectal liver metastases: A cost-effectiveness analysis. Ann Surg. 2000;232:763–776.CrossRefGoogle ScholarPubMed
4. Brown, G, Davies, S, Williams, GT, et al. Effectiveness of preoperative staging in rectal cancer: Digital rectal examination, endoluminal ultrasound or magnetic resonance imaging? Br J Cancer. 2004;91:23–29.CrossRefGoogle ScholarPubMed
5. Cassidy, J, Douillard, JY, Twelves, C, et al. Pharmacoeconomic analysis of adjuvant oral capecitabine vs intravenous 5-FU/LV in Dukes’ C colon cancer: The X-ACT trial. Br J Cancer. 2006;94:1122–1129.CrossRefGoogle Scholar
6. Chaudhri, S, Brown, L, Hassan, I, et al. Preoperative intensive, community-based vs. traditional stoma education: A randomized, controlled trial. Dis Colon Rectum. 2005;48:504–509.CrossRefGoogle ScholarPubMed
7. Chilcott, JB, Tappenden, P, Rawdin, A, et al. Avoiding and identifying errors in health technology assessment models. Health Technol Assess. In press.Google Scholar
8. Cunningham, D. Mature results from three large controlled studies with raltitrexed (‘Tomudex’). Br J Cancer. 1998;77 (Suppl 2):15–21.CrossRefGoogle ScholarPubMed
9. Cunningham, D, Falk, S, Jackson, D. Clinical and economic benefits of irinotecan in combination with 5-fluorouracil and folinic acid as first line treatment of metastatic colorectal cancer. Br J Cancer. 2002;86:1677–1683.CrossRefGoogle ScholarPubMed
10. Daniels, K, McKee, M. Options for screening for colorectal cancer in the Royal Air Force: A cost-effectiveness evaluation. J R Army Med Corps. 1995;141:142–150.CrossRefGoogle Scholar
11. de Verteuil, RM, Hernandez, RA, Vale, L, et al. Economic evaluation of laparoscopic surgery for colorectal cancer. Int J Technol Assess Health Care. 2007;23:464–472.CrossRefGoogle ScholarPubMed
12. Durand-Zaleski, I, Earlam, S, Fordy, C, Davies, M, Allen-Mersh, TG. Cost-effectiveness of systemic and regional chemotherapy for the treatment of patients with unresectable colorectal liver metastases. Cancer. 1998;83:882–888.3.0.CO;2-R>CrossRefGoogle ScholarPubMed
13. Eccersley, AJ, Williams, NS. Anorectal reconstruction–restoring continence after abdominoperineal excision of the anorectum. Ital J Gastroenterol Hepatol. 1998;30:549–554.Google Scholar
14. Eggington, S, Tappenden, P, Pandor, A, et al. Cost-effectiveness of oxaliplatin and capecitabine in the adjuvant treatment of stage III colon cancer. Br J Cancer. 2006;95:1195–1201.CrossRefGoogle ScholarPubMed
15. Franks, PJ, Bosanquet, N, Thorpe, H, et al. Short-term costs of conventional vs laparoscopic assisted surgery in patients with colorectal cancer (MRC CLASICC trial). Br J Cancer. 2006;95:6–12.CrossRefGoogle ScholarPubMed
16. Hale, JP, Cohen, DR, Maughan, TS, Stephens, RJ. Costs and consequences of different chemotherapy regimens in metastatic colorectal cancer. Br J Cancer. 2002;86:1684–1690.CrossRefGoogle ScholarPubMed
17. Hind, D, Tappenden, P, Tumur, I, et al. The use of irinotecan, oxaliplatin and raltitrexed for the treatment of advanced colorectal cancer: Systematic review and economic evaluation. Health Technol Assess. 2008;12:1–182.Google Scholar
18. Iveson, TJ, Hickish, T, Schmitt, C, Van Cutsem, E. Irinotecan in second-line treatment of metastatic colorectal cancer: Improved survival and cost-effect compared with infusional 5-FU. Eur J Cancer. 1999;35:1796–1804.CrossRefGoogle ScholarPubMed
19. Kerr, D, O'Connor, KM. An economic comparison of the net clinical benefit and treatment costs of raltitrexed and 5-fluorouracil + leucovorin (Mayo regimen) in advanced colorectal cancer. J Med Econ. 1999;2:123–132.Google Scholar
20. King, PM, Blazeby, JM, Ewings, P, et al. Randomized clinical trial comparing laparoscopic and open surgery for colorectal cancer within an enhanced recovery programme. Br J Surg. 2006;93:300–308.CrossRefGoogle ScholarPubMed
21. King, PM, Blazeby, JM, Ewings, P, et al. The influence of an enhanced recovery programme on clinical outcomes, costs and quality of life after surgery for colorectal cancer. Colorectal Dis. 2006;8:506–513.CrossRefGoogle ScholarPubMed
22. Lloyd, JM, Hummel, S, Bansback, N, Orr, B, Seymour, M. A rapid and systematic review of the evidence for the clinical effectiveness and cost-effectiveness of irinotecan, oxaliplatin and raltitrexed for the treatment of advanced colorectal cancer. Health Technol Assess. 2001;5:1–128.Google Scholar
23. Macafee, DAL, Whynes, DK, Scholefield, JH. Risk-stratified intensive follow up for treated colorectal cancer – Realistic and cost saving? Colorectal Dis. 2008;10:222–230.Google Scholar
24. Maslekar, S, Pillinger, SH, Sharma, A, et al. Cost analysis of transanal endoscopic microsurgery for rectal tumours. Colorectal Dis. 2007;9:229–234.CrossRefGoogle ScholarPubMed
25. Mihai, R, Borley, N. Transanal endoscopic microsurgery – impact on the practice of a colorectal surgeon in a district general hospital. Ann R Coll Surg Engl. 2005;87:432–436.CrossRefGoogle Scholar
26. National Institute for Health and Clinical Excellence. Guide to the methods of technology appraisal. London: NICE; 2008.Google Scholar
27. Neilson, AR, Walker, A, Forbes, D. Evaluation of the UK colorectal cancer screening pilot: Final report. Chapter 5: Health Economics. 92–104. 2003. http://www.cancerscreening.nhs.uk/bowel/finalreport.pdf (accessed April 15, 2008).Google Scholar
28. Nicholls, CJ, Cassidy, J, Freemantle, N, Harrison, M, Carita, P. Cost-effectiveness of combination chemotherapy (oxaliplatin or irinotecan in combination with 5-FU/FA) compared with 5-FU/FA alone. J Med Econ. 2001;4:115–125.CrossRefGoogle Scholar
29. Nicholls, CJ, Cassidy, J, Freemantle, N, Harrison, M, Carita, P. Cost-effectiveness of oxaliplatin in combination with 5-FU/FA compared with 5-FU/FA alone. J Med Econ. 2001;4:127–135.CrossRefGoogle Scholar
30. Noblett, SE, Horgan, AF. A prospective case-matched comparison of clinical and financial outcomes of open versus laparoscopic colorectal resection. Surg Endosc. 2007;21:404–408.CrossRefGoogle ScholarPubMed
31. Poston, G, Benjamin, IS, Diamond, T, et al. Costs of neoadjuvant chemotherapy and surgery in patients with liver metastases from advanced colorectal cancer. J Med Econ. 2001;4:167–177.CrossRefGoogle Scholar
32. Renehan, AG, O'Dwyer, ST, Whynes, DK. Cost effectiveness analysis of intensive versus conventional follow up after curative resection for colorectal cancer. BMJ. 2004;328:81–84.CrossRefGoogle ScholarPubMed
33. Robert, G, Brown, J, Garvican, L. Cost of quality management and information provision for screening: Colorectal cancer screening. J Med Screen. 2000;7:31–34.CrossRefGoogle ScholarPubMed
34. Robinson, MH, Marks, CG, Farrands, PA, et al. Is an immunological faecal occult blood test better than Haemoccult? A cost-benefit study. Eur J Surg Oncol 1995;21:261–264.Google Scholar
35. Rowe, MW, Valle, JW, Swindell, R, Fitzsimmons, L, James, RD. New face for a familiar friend: The deGramont regimen in the treatment of metastatic colorectal cancer given as an outpatient: A feasibility study. J Oncol Pharm Pract. 2002;8:97–103.CrossRefGoogle Scholar
36. Starling, N, Tilden, D, White, J, Cunningham, D. Cost-effectiveness analysis of cetuximab/irinotecan vs active/best supportive care for the treatment of metastatic colorectal cancer patients who have failed previous chemotherapy treatment. Br J Cancer. 2007;96:206–212.CrossRefGoogle ScholarPubMed
37. Tappenden, P, Chilcott, J, Eggington, S, et al. Option appraisal of population-based colorectal cancer screening programmes in England. Gut. 2007;56:677–684.CrossRefGoogle ScholarPubMed
38. Tappenden, P, Jones, R, Paisley, S, et al. Systematic review and economic evaluation of bevacizumab and cetuximab for the treatment of metastatic colorectal cancer. Health Technol Assess. 2007;11:1–128.Google Scholar
39. Tappenden, P, Jones, R, Paisley, S, Carroll, C. The cost-effectiveness of bevacizumab in the first-line treatment of metastatic colorectal cancer in England and Wales. Eur J Cancer. 2007;43:2487–2494.CrossRefGoogle ScholarPubMed
40. Trueman, P, Chilcott, JB, Tappenden, P et al. , Bowel cancer services: Costs and benefits. 2007. Final report to the Department of Health. http://www.shef.ac.uk/scharr/sections/heds/modelling/colorectal-cancers.html (accessed February 3, 2008).Google Scholar
41. Vellacott, KD, Clarke, D, Beech, C, Joshi, H. Flexible sigmoidoscopy in general practice. Colorectal Dis. 2002;4:123–126.CrossRefGoogle ScholarPubMed
42. Walker, AR, Whynes, DK, Thomas, WM, et al. Retesting positive results in screening for colorectal cancer: A marginal analysis. Appl Econ. 1993;23:1015–1017.CrossRefGoogle Scholar
43. Walker, A, Whynes, DK, Chamberlain, JO, et al. The cost of screening for colorectal cancer. J Epidemiol Community Health. 1991;45:220–224.Google Scholar
44. Walker, A, Whynes, DK. Filtering strategies in mass population screening for colorectal cancer: An economic evaluation. Med Decis Making. 1992;12:2–7.CrossRefGoogle ScholarPubMed
45. Walker, AR, Whynes, DK, Hardcastle, JD. Rehydration of guaiac-based faecal occult blood tests in mass screening for colorectal cancer. An economic perspective. Scand J Gastroenterol. 1991;26:215–218.CrossRefGoogle ScholarPubMed
46. Ward, SE, Kaltenthaler, E, Cowan, J, et al. The clinical and economic benefits of capecitabine and tegafur with uracil in metastatic colorectal cancer. Br J Cancer. 2006;95:27–34.CrossRefGoogle ScholarPubMed
47. Whynes, DK. Cost-effectiveness of screening for colorectal cancer: Evidence from the Nottingham faecal occult blood trial. J Med Screen. 2004;11:11–15.CrossRefGoogle ScholarPubMed
48. Whynes, DK, Walker, AR, Hardcastle, JD. Cost-effective screening strategies for colorectal cancer. J Public Health Med. 1992;14:43–49.Google ScholarPubMed
49. Whynes, DK, Walker, AR, Hardcastle, JD, et al. Cost savings in mass population screening for colorectal cancer resulting from the early detection and excision of adenomas. Health Econ. 1992;1:53–60.CrossRefGoogle ScholarPubMed
50. Whynes, DK. Neilson, AR, Walker, AR, et al. Faecal occult blood screening for colorectal cancer: Is it cost-effective? Health Econ. 1998;7:21–29.3.0.CO;2-9>CrossRefGoogle ScholarPubMed
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