Delcò F, Egger R, Bauerfeind P, Beglinger C
Department of Medicine, Division of Gastroenterology, University Hospital of Basel, Basel, Switzerland.
Aliment Pharmacol Ther. 2005 Mar 1;21(5):615-22. doi: 10.1111/j.1365-2036.2005.02362.x.
In industrialized countries, colorectal cancer is a leading cause of morbidity and mortality. Decisions on colorectal cancer screening are based on cost-effectiveness analyses that rely on colorectal cancer cost studies. Additionally, the study of the resource utilization pattern may lead to cost-saving strategies in the care of colorectal cancer.
To estimate hospital resource utilization, the use of various therapy modalities and costs of colorectal cancer cases undergoing surgery during the first 3 years following the diagnosis at a Swiss university hospital.
Consecutive colorectal cancer patients from 1997 to 1998 were identified using the surgery database of the University Hospital of Basel and followed for a period of 3 years. In-hospital resource utilization and costs were retrieved from the computerized administrative records. Treatment outside of the hospital during the study period constituted an exclusion criterion.
Eighty-three (94%) of 89 patients undergoing surgery for colorectal cancer were included in the study, 58 with colon cancer and 25 with rectal cancer. The average ages were 70.3 and 63.6 years, respectively. Overall, 59% of the patients were treated with surgery alone, 27% also had chemotherapy and 15% received additional chemoradiotherapy. These percentages and resource utilization varied broadly between the two colorectal cancer groups. On average, patients were admitted to the hospital 2.7 times and the hospital length of stay amounted to 35 days. They were visited by doctors 69 times, and examined with colonoscopy, ultrasonography and computerized tomography 2.7, 3.2 and 2.4 times, respectively. Mean costs incurred for rectal cancer (US dollars 40,230) were about 22% higher than for colon cancer patients (US dollars 33,079). Hospitalization and surgical therapy generated the greatest costs. Expenses were highest for the first year and with more severe disease stages at diagnosis.
Colorectal cancer is an expensive disease. Economic analyses on screening should take into account the large resource utilization and cost variability by performing sensitivity analysis on broad cost ranges. Furthermore, they should consider stage shifting at diagnosis and include stage-specific costs.
在工业化国家，结直肠癌是发病和死亡的主要原因。结直肠癌筛查决策基于成本效益分析，而成本效益分析依赖于结直肠癌成本研究。此外，对资源利用模式的研究可能会带来结直肠癌护理中的成本节约策略。
估计瑞士一家大学医院诊断后前3年接受手术的结直肠癌病例的医院资源利用、各种治疗方式的使用情况及成本。
利用巴塞尔大学医院的手术数据库识别1997年至1998年连续的结直肠癌患者，并随访3年。从计算机化行政记录中获取住院资源利用情况和成本。研究期间在院外的治疗构成排除标准。
89例接受结直肠癌手术的患者中有83例（94%）纳入研究，其中58例为结肠癌患者，25例为直肠癌患者。平均年龄分别为70.3岁和63.6岁。总体而言，59%的患者仅接受手术治疗，27%的患者还接受了化疗，15%的患者接受了额外的放化疗。这两个结直肠癌组之间这些百分比和资源利用情况差异很大。患者平均住院2.7次，住院时间为35天。他们看医生69次，分别接受结肠镜检查、超声检查和计算机断层扫描2.7次、3.2次和2.4次。直肠癌患者的平均费用（40230美元）比结肠癌患者（33079美元）高出约22%。住院和手术治疗产生的费用最高。第一年费用最高，诊断时疾病分期越严重费用越高。
结直肠癌是一种昂贵的疾病。筛查的经济分析应通过对广泛成本范围进行敏感性分析，考虑到大量的资源利用和成本变异性。此外，应考虑诊断时的分期变化并纳入特定分期的成本。
