D.A.L. Macafee¹, J. West², J.H. Scholefield³ and D.K. Whynes⁴

¹Specialist Registrar in General Surgery, Department of Paediatric Surgery, Royal Victoria Infirmary, Newcastle upon Tyne. ²Specialist Registrar in Gastroenterology and Clinical Scientist, Division of Epidemiology and Public Health, University of Nottingham, Queen’s Medical Centre, Nottingham. ³Professor of Surgery,Division of Gastrointestinal Surgery, Wolfson Digestive Diseases Centre, Nottingham University Hospitals, Queen’s Medical Centre, Nottingham NG7 2UH. ⁴Professor of Health Economics, School of Economics, University of Nottingham.

Abstract

Background: Colorectal cancer is the second commonest cause of cancer death and the cost to primary care has not been estimated.

Aim: To determine the direct primary care costs of colorectal cancer care.

Design: Retrospective case note review.

Setting: Nottingham, United Kingdom.

Methods: We identified people with colorectal cancer between 1995 and 1998, from computerised pathology records. Colorectal cancer related resources consumed in primary care, from hospital discharge to death, were identified from retrospective notes review. Outcome measures were costs incurred by the General Practitioner (GP) and the total cost to primary care. We used multiple linear regression to identify predictors of cost.

Results: Of 416 people identified from pathology records, the median age at primary operation of the 135 (33%) people we selected was 74.2 (IQR 14.4) years, 75 (56%) were male. The median GP cost was: Dukes A £61.0 (IQR 516.2) and Dukes D £936.2 (1196.2) p  0.01. The geometric mean ratio found Dukes D cancers to be 10 times as costly as Dukes A. The median total cost was: Dukes A £1038.3 (IQR 5090.6) and Dukes D £1815.2 (2092.5) p = 0.06. Using multivariate analysis, Dukes stage was the most important predictor of GP costs. For total costs, the presence of a permanent stoma was the most predictive variable, followed by adjuvant therapy and advanced Dukes stage (Dukes C and D).

Conclusions: Contrary to hospital based care costs, late stage disease (Dukes D) costs substantially more to general practice than any other stage. Stoma care products are the most costly prescribable item. Costs savings may be realised in primary care by screening detection of early stage colorectal cancers.