• Filipa Esgalhado NOVA School of Science and Technology, NOVA University Lisbon, 2829-516 Caparica, Portugal
  • Luís Antunes IQVIA Portugal: Porto Salvo, Lisboa, Portugal
  • Marina Borges IQVIA Portugal: Porto Salvo, Lisboa, Portugal
  • Pedro Medeiros Epidemiology, Results, Economy and Management Group in Oncology, IPO Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal
  • Joaquim Abreu Sousa Surgical Oncology Service, Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal
  • Lúcio Lara Santos Experimental Pathology and Therapeutics Group, IPO Porto Research Center (CI-IPOP) and Surgical Oncology Department – Portuguese Institute of Oncology, Porto, Portugal
  • Maria José Bento Epidemiology, Results, Economy and Management Group in Oncology, IPO Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal


Background: Colorectal cancer is the second most common cancer in Portugal, which imposes an economic
burden in the restricted health care budget. The aim of this study was to estimate the effects of age, stage, gender, Eastern Cooperative Oncology Group performance status, Charlson Comorbidity Index and category of health care activity on the average colorectal cancer treatment costs based on hospital records before COVID19 pandemic.
Methods: The average monthly costs were estimated in three phases: initial, monitoring and final based on the costs of the patient’s hospital activities. The Kruskal Wallis test was applied to identify treatment costs differences within groups.
Results: The study population included 3020 patients diagnosed with colorectal cancer. Hospitalization, younger patients and higher stages were the main contributors for colorectal cancer costs. Stage IV presented a distinctive cost profile. Significant cost differences were found between age groups and stage in all phases. In the first 24 months after diagnosis, treating a colorectal cancer patient in stage I, II, III and IV, cost in average, 5590, 9180, 13300 and 28450 euros, respectively. Patients with Charlson Comorbidity Index score 0 were more expensive than patients with higher scores.
Conclusion: Our findings illustrate the value of costs studies based on national databases. This study showed the impact of several variables in the costs of colorectal cancer treatment, before COVID 19 pandemic, which may be used to improve the budget distribution of the Portuguese health care system.


Download data is not yet available.


1. F. Bray, J. Ferlay, I. Soerjomataram, R. L. Siegel, L. A. Torre, and A. Jemal, “Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries,” CA. Cancer J. Clin., vol. 68, no. 6, pp. 394–424, Nov. 2018.
2. I. P. O. do Porto, “Registo Oncológico Regional do Norte 2011,” 2017.
3. J. Pereira, Economia da Saúde: glossário de termos e conceitos. Associação Portuguesa de Economia da Saúde, 2004.
4. J. Machado Lopes, F. Rocha Gonçalves, M. Borges, P. Redondo, and J. Laranja Pontes, “The cost of cancer treatment in Portugal,” Ecancermedicalscience, vol. 11, pp. 1–10, Sep. 2017.
5. R. Luengo-Fernandez, J. Leal, A. Gray, and R. Sullivan, “Economic burden of cancer across the European Union: a population-based cost analysis,” Lancet Oncol., vol. 14, no. 12, pp. 1165–1174, Nov. 2013.
6. A. Araújo et al., “Custo do tratamento do cancro em Portugal,” Acta Med. Port., pp. 525–536, 2009.
7. X. Q. Yu, D. P. Smith, M. S. Clements, M. I. Patel, B. McHugh, and D. L. O’Connell, “Projecting prevalence by stage of care for prostate cancer and estimating future health service needs: protocol for a modelling study,” BMJ Open, vol. 1, no. 1, pp. e000104–e000104, Sep. 2011.
8. J. L. Warren, K. R. Yabroff, A. Meekins, M. Topor, E. B. Lamont, and M. L. Brown, “Evaluation of Trends in the Cost of Initial Cancer Treatment,” JNCI J. Natl. Cancer Inst., vol. 100, no. 12, pp. 888–897, Jun. 2008.
9. C. de Oliveira et al., “Understanding the costs of cancer care before and after diagnosis for the 21 most common cancers in Ontario: a population-based descriptive study,” C. Open, vol. 1, no. 1, pp. E1–E8, Jan. 2013.
10. C. de Oliveira et al., “Trends in use and cost of initial cancer treatment in Ontario: a population-based descriptive study,” C. Open, vol. 1, no. 4, pp. E151–E158, Dec. 2013.
11. M. L. Brown, G. F. Riley, N. Schussler, and R. Etzioni, “Estimating health care costs related to cancer treatment from SEER-Medicare data.,” Med. Care, vol. 40, no. 8 Suppl, p. IV-104-17, Aug. 2002.
12. K. R. Yabroff, A. B. Mariotto, E. Feuer, and M. L. Brown, “Projections of the costs associated with colorectal cancer care in the United States, 2000–2020,” Health Econ., vol. 17, no. 8, pp. 947–959, Aug. 2008.
13. A. B. Mariotto, K. R. Yabroff, E. J. Feuer, R. De Angelis, and M. Brown, “Projecting the number of patients with colorectal carcinoma by phases of care in the US: 2000–2020,” Cancer Causes Control, vol. 17, no. 10, pp. 1215–1226, Dec. 2006.
14. T. A. Hodgson, “Annual Costs of Illness versus Lifetime Costs of Illness and Implications of Structural Change,” Drug Inf. J., vol. 22, no. 3, pp. 323–341, Jul. 1988.
15. S. Francisci et al., “Cost profiles of colorectal cancer patients in Italy based on individual patterns of care,” BMC Cancer, vol. 13, no. 1, p. 329, Dec. 2013.
16. L. E. Cipriano et al., “Lung cancer treatment costs, including patient responsibility, by disease stage and treatment modality, 1992 to 2003,” Value Heal., vol. 14, no. 1, pp. 41–52, Jan. 2011.
17. M. E. Stokes, J. Ishak, I. Proskorovsky, L. K. Black, and Y. Huang, “Lifetime economic burden of prostate cancer,” BMC Health Serv. Res., vol. 11, no. 1, p. 349, Dec. 2011.
18. V. Teixeira, “Custos diretos do tratamento do cancro do cólon no algarve,” Universidade Nova de Lisboa, 2012.
19. I. P. de O. do Porto, “Projeções da incidência de cancro na Região Norte - 2013, 2015 e 2020,” 2013.
20. K. R. Yabroff et al., “Cost of Care for Elderly Cancer Patients in the United States,” JNCI J. Natl. Cancer Inst., vol. 100, no. 9, pp. 630–641, May 2008.
21. V. Neuhaus, J. King, M. G. Hageman, and D. C. Ring, “Charlson Comorbidity Indices and In-hospital Deaths in Patients with Hip Fractures,” Clin. Orthop. Relat. Res., vol. 471, no. 5, pp. 1712–1719, May 2013.
22. H. G. Prigerson et al., “Chemotherapy Use, Performance Status, and Quality of Life at the End of Life,” JAMA Oncol., vol. 1, no. 6, p. 778, Sep. 2015.
23. K. R. Yabroff, J. Lund, D. Kepka, and A. Mariotto, “Economic Burden of Cancer in the United States: Estimates, Projections, and Future Research,” Cancer Epidemiol. Biomarkers Prev., vol. 20, no. 10, pp. 2006–2014, Oct. 2011.
24. S. D. Ramsey, D. Ph, K. Berry, D. Ph, R. Etzioni, and D. Ph, “Lifetime Cancer-Attributable Cost of Care for Long Term Survivors of Colorectal Cancer,” vol. 97, no. 2, pp. 2–7, 2002.
25. K. Lang, L. M. Lines, D. W. Lee, J. R. Korn, C. C. Earle, and J. Menzin, “Lifetime and Treatment-Phase Costs Associated With Colorectal Cancer: Evidence from SEER-Medicare Data,” Clin. Gastroenterol. Hepatol., vol. 7, no. 2, pp. 198–204, Feb. 2009.
26. L. Clerc et al., “Cost of care of colorectal cancers according to health care patterns and stage at diagnosis in France,” Eur. J. Heal.
Econ., vol. 9, no. 4, pp. 361–367, Nov. 2008. 27. D. J. Sargent et al., “A Pooled Analysis of Adjuvant Chemotherapy for Resected Colon Cancer in Elderly Patients,” N. Engl. J. Med., vol. 345, no. 15, pp. 1091–1097, Oct. 2001.
28. L. Tilson et al., “Cost of care for colorectal cancer in Ireland: a health care payer perspective,” Eur. J. Heal. Econ., vol. 13, no. 4, pp. 511–524, Aug. 2012.
29. N. Miranda and C. Portugal, “Avaliação e Monitorização dos Rastreios Oncológicos Organizados de Base Populacional de Portugal Continental,” 2014.
30. G. F. Riley, A. L. Potosky, J. D. Lubitz, and L. G. Kessler, “Medicare Payments from Diagnosis to Death for Elderly Cancer Patients by Stage at Diagnosis,” Med. Care, vol. 33, no. 8, pp. 828–841, Aug. 1995.
31. F. Delco, R. Egger, P. Bauerfeind, and C. Beglinger, “Hospital health care resource utilization and costs of colorectal cancer during the first 3-year period following diagnosis in Switzerland,” Aliment. Pharmacol. Ther., vol. 21, no. 5, pp. 615–622, Mar. 2005.
32. S.-J. Yoon, E.-J. Kim, H.-J. Seo, and I.-H. Oh, “The Association between Charlson Comorbidity Index and the Medical Care Cost of Cancer: A Retrospective Study,” Biomed Res. Int., vol. 2015, pp. 1–6, 2015.
33. J. Laranja Pontes, F. R. Gonçalves, and Marina, “Conhecer os custos para melhor tratar os doentes - o caso da oncologia,” Assoc. Port. Adm. Hosp., no. 5, pp. 14–18, 2015.
34. C. G. Pinto, A. T. Paquete, and I. Pissarra, “Colorectal cancer in Portugal,” Eur. J. Heal. Econ., vol. 10, no. S1, pp. 65–73, Jan. 2010.
How to Cite
ESGALHADO, Filipa et al. EVALUATION OF THE COSTS OF COLORECTAL CANCER TREATMENT ACCORDING TO PHASE OF CARE IN AN ONCOLOGY REFERENCE CENTRE BEFORE COVID 19 PANDEMIC. Revista Portuguesa de Cirurgia, [S.l.], n. 56, p. 23-33, jan. 2024. ISSN 2183-1165. Available at: <https://revista.spcir.com/index.php/spcir/article/view/1022>. Date accessed: 12 july 2024. doi: https://doi.org/10.34635/rpc.1022.
Original Papers

Most read articles by the same author(s)