Patterns of care and cost profiles of cancer patients in Italy: the EPICOST study.

BACKGROUND In most countries cancer accounts for a major proportion of national health expenditures, due to population changes in risk factor prevalence, prevention efforts and population aging. Measuring the burden of disease is of great interest to public health researchers and policy makers. METHODS We reconstruct the cancer pathway and the cost-related dynamic according to 3 phases of care: initial, continuing and final. Profiles of cancer-related costs are built using administrative data (hospital admissions, outpatients and pharmaceutical data) linked with cancer registry data. Cancer sites under study are colon, rectum and breast; 8 Italian registries participate in the study. RESULTS Preliminary results for colo-rectal cancer show cost profiles with higher costs during the first months of the initial phase, then reaching a plateau during the continuing phase and increasing again during the final phase of life. There is a trend in costs by stage at diagnosis in the initial phase: more advanced stages correspond to higher average costs. Age is also related to costs: younger patients have higher costs in all phases of the disease. CONCLUSION AND DISCUSSION The phase-of-care approach allows the estimation of patterns of care and costs at a given date, taking into account the survivors' distribution and their care needs during lifespan. The results confirm the importance of primary prevention and early detection of cancer in a public health perspective, not only in the improvement of patient survival and but also in the economic sustainability of health care. The methodology can be used to compare patterns of care in different countries.