Cost-effectiveness and work ability in colorectal cancer : Towards maintaining sustainable cancer healthcare

Abstract

Despite advances in effective cancer treatments, healthcare costs continue to rise. This could be a threat to maintain a balanced healthcare system in the future. This thesis illustrates challenges in cost-effectiveness studies for colorectal cancer. Cost-effectiveness is often evaluated based on clinical randomised studies. Nevertheless, many assumptions are made, for example costs due to treatment side effects, thereby influencing cost-effectiveness research outcomes. We also demonstrate that the methodology for a cost-effectiveness model could influence the outcomes. Furthermore, quality of life measured with generic questionnaires is an important parameter in cost-effectiveness models. This dissertation shows that if only disease-specific questionnaires are available, an algorithm can be used to calculate cost-effectiveness in which quality of life is accounted for. Current cost-effectiveness research usually only gives an impression on institutional costs based on randomized studies. While cost-effectiveness should be about the social impact of a treatment, in order to use our healthcare budget more efficiently. As we have shown that following the diagnosis of colon cancer work ability is reduced for a prolonged time, it should be considered to take such socially relevant costs into account. The future treatment of colorectal cancer will be increasingly personalized. In order to investigate the effectiveness and cost-effectiveness of personalized treatments, clinical trials will need to be designed differently. An example of such a new study design, is the Dutch Prospective ColoRectal Cancer (PLCRC) cohort developed to collect clinical data, biomaterial and questionnaires from colorectal cancer patients from diagnosis until death. Nevertheless, the evaluation of cost-effectiveness from a social perspective will remain a challenge as it is impossible to record all (societal) costs.