Original Article

Resource Use and Costs Associated to the Initial Phase of Treatment for Patients with Colorectal Cancer Receiving Post-Surgery Chemotherapy: A Cost Analysis from a Healthcare Perspective


Background: To estimate the resource use and costs associated to the initial phase of treatment for colorectal cancer in Iran.

Methods: A retrospective study was conducted using routinely collected data within Electronic Health Records System (SEPAS), a national database representing public hospitals in Iran between March 20, 2016 and March 19, 2017. Primary end points included healthcare resource use, direct medical and non-medical costs of care in the 12-month study period.

Results: The study population included 657 patients with colorectal cancer who underwent surgery and the follow-up chemotherapy. We estimated a total direct cost of $21,407 per patient. The results indicated that direct medical costs were primarily driven by inpatient hospital care, followed by surgery, chemotherapy, and diagnostic services.

Conclusion: The initial 12-month of treatment for colorectal cancer, including surgery and the follow-up chemotherapy, is resource intensive. The total direct costs associated to the disease are remarkable, with Inpatient hospital services being the main contributor followed by surgery and chemotherapy.

1. Bray F, Ferlay J, Soerjomataram I, et al (2018). Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 68(6): 394-424.
2. Ferlay J, Colombet M, Soerjomataram I, et al (2019). Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods. Int J Cancer, 144(8): 1941-1953.
3. Douaiher J, Ravipati A, Grams B, et al (2017). Colorectal cancer-global burden, trends, and geographical variations. J Surg Oncol. 115(5):619-630.
4. Redaelli A, Cranor CW, Okano GJ, et al (2003). Screening, prevention and socioeconomic costs associated with the treatment of colorectal cancer. PharmacoEconomics, 21(17): 1213-38.
5. Kriza C, Emmert M, Wahlster P, et al (2013). Cost of illness in colorectal cancer: an international review. PharmacoEconomics, 31(7): 577-88.
6. Cheung DY, Kim TH, Kim CW, et al (2008). The anatomical distribution of colorectal cancer in Korea: evaluation of the incidence of proximal and distal lesions and synchronous adenomas. Intern Med, 47(19):1649-54.
7. Vardanjani HM, Haghdoost A, Bagheri-Lankarani K, et al (2018). Estimation and Projection of Prevalence of Colorectal Cancer in Iran, 2015-2020. ABR, 7:20.
8. Mohagheghi MA, Mosavi-Jarrahi A, Malekzadeh R, et al (2009). Cancer incidence in Tehran metropolis: the first report from the Tehran Population-based Cancer Registry, 1998-2001. IJMS, 12(1): 15-23.
9. Mahmoudlou A, Yavari P, Abolhasani F, et al (2014). Estimation of the Attributable Burden of Colorectal Cancer in Iran in 2008.irje, 9(2):1-9.
10. Davari M, Maracy MR, Emami MH, et al (2012). The Direct Medical Costs of Colorectal Cancer in Iran; Analyzing the Patient's Level Data from a Cancer Specific Hospital in Isfahan. Int J Prev Med, 3(12):887-892.
11. Kamal KM, Covvey JR, Dashputre A, et al (2017). A Systematic Review of the Effect of Cancer Treatment on Work Productivity of Patients and Caregivers. J Manag Care Spec Pharm, 23(2): 136-162.
12. Al-Badriyeh D, Alameri M, Al-Okka R (2017). Cost-effectiveness research in cancer therapy: a systematic review of literature trends, methods and the influence of funding. BMJ Open, 7(1): e012648.
13. Wissinger E, Griebsch I, Lungershausen J, et al (2014). The economic burden of head and neck cancer: a systematic literature review. Pharmacoeconomics, 32(9): 865-82.
14. Geynisman DM, Chien CR, Smieliauskas F, et al (2014). Economic evaluation of therapeutic cancer vaccines and immunotherapy: a systematic review. Hum vaccin immunother, 10(11): 3415-24.
15. Shih YC, Smieliauskas F, Geynisman DM, et al (2015). Trends in the Cost and Use of Targeted Cancer Therapies for the Privately Insured Nonelderly: 2001 to 2011. J Clin Oncol, 33(19): 2190-6.
16. Seo MK, Cairns J (2018). Do cancer biomarkers make targeted therapies cost-effective? A systematic review in metastatic colorectal cancer. PloS One, 13(9): e0204496.
17. Yabroff KR, Lund J, Kepka D, Mariotto A (2011). Economic burden of cancer in the United States: estimates, projections, and future research. Cancer Epidemiol Biomarkers Prev, 20(10): 2006-2014.
18. Hall PS, Hamilton P, Hulme CT, et al (2015). Costs of cancer care for use in economic evaluation: a UK analysis of patient-level routine health system data. Br J Cancer , 112(5): 948-56.
19. The World Bank (2019). PPP conversion factor, GDP (LCU per international $). Available from: https://data.worldbank.org/indicator/PA.NUS.PPP?locations=IR
20. Bank TW (2019). World Development Indicators: Exchange rates and prices. Available from: http://wdi.worldbank.org/table/4.16
21. Mar J, Errasti J, Soto-Gordoa M, et al (2017). The cost of colorectal cancer according to the TNM stage. Cir Esp, 95(2): 89-96.
22. Corral J, Castells X, Molins E, et al (2016). Long-term costs of colorectal cancer treatment in Spain. BMC Health Serv Res, 16:56.
23. Ananda S, Kosmider S, Tran B, et al(2016). The rapidly escalating cost of treating colorectal cancer in Australia. Asia Pac J Clin Oncol, 12(1): 33-40.
24. Goldsbury DE, Yap S, Weber MF, et al (2018). Health services costs for cancer care in Australia: Estimates from the 45 and Up Study. PloS One, 13(7): e0201552.
25. Haug U, Engel S, Verheyen F, et al (2014). Estimating colorectal cancer treatment costs: a pragmatic approach exemplified by health insurance data from Germany. PloS One, 9(2): e88407.
26. Farkkila N, Torvinen S, Sintonen H, et al (2018). Costs of colorectal cancer in different states of the disease. Acta Oncol, 54(4): 454-62.
27. Sagar B, Lin YS, Castel LD (2017). Cost drivers for breast, lung, and colorectal cancer care in a commercially insured population over a 6-month episode: an economic analysis from a health plan perspective. J Med Econ, 20(10): 1018-1023.
28. Vahdatimanesh Z, Zendehdel K, Kbari Sari AA, et al (2017). Economic burden of colorectal cancer in Iran in 2012. Med J Islam Repub Iran, 31:115.
29. Nejati M, Razavi M, Harirchi I, et al (2019). The impact of provider payment reforms and associated care delivery models on cost and quality in cancer care: A systematic literature review. PloS One, 14(4): e0214382.
IssueVol 50 No 9 (2021) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijph.v50i9.7062
Colorectal cancer Costs Direct medical costs Resource use

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Nejati M, Razavi M, Harirchi I, Zanganeh M, Salari G, Tabatabaee SM. Resource Use and Costs Associated to the Initial Phase of Treatment for Patients with Colorectal Cancer Receiving Post-Surgery Chemotherapy: A Cost Analysis from a Healthcare Perspective. Iran J Public Health. 2021;50(9):1887-1896.