Survival and costs of colorectal cancer treatment and effects of changing treatment strategies: a model approach

  • Paal JorangerEmail author
  • Arild Nesbakken
  • Halfdan Sorbye
  • Geir Hoff
  • Arne Oshaug
  • Eline Aas
Original Paper


New and emerging advances in colorectal cancer (CRC) treatment combined with limited healthcare resources highlight the need for detailed decision-analytic models to evaluate costs, survival and quality-adjusted life years. The objectives of this article were to estimate the expected lifetime treatment cost of CRC for an average 70-year-old patient and to test the applicability and flexibility of a model in predicting survival and costs of changing treatment scenarios. The analyses were based on a validated semi-Markov model using data from a Norwegian observational study (2049 CRC patients) to estimate transition probabilities and the proportion resected. In addition, inputs from the Norwegian Patient Registry, guidelines, literature, and expert opinions were used to estimate resource use. We found that the expected lifetime treatment cost for a 70-year-old CRC patient was €47,300 (CRC stage I €26,630, II €38,130, III €56,800, and IV €69,890). Altered use of palliative chemotherapy would increase the costs by up to 29%. A 5% point reduction in recurrence rate for stages I–III would reduce the costs by 5.3% and increase overall survival by 8.2 months. Given the Norwegian willingness to pay threshold per QALY gained, society’s willingness to pay for interventions that could result in such a reduction was on average €28,540 per CRC patient. The life years gained by CRC treatment were 6.05 years. The overall CRC treatment costs appear to be low compared to the health gain, and the use of palliative chemotherapy can have a major impact on cost. The model was found to be flexible and applicable for estimating the cost and survival of several CRC treatment scenarios.


Colorectal cancer Markov model Cost Surgery Chemotherapy Analyse innovations 



Nordic FLv = 5-fluorouracil/folinic acid


Confidence interval




Colorectal cancer


Credible interval


Epidermal growth factor receptor inhibitors (cetuximab/panitumumab)


A combination of irinotecan and 5-fluorouracil/folinic acid


A combination of oxaliplatin and 5-FU/FA


Faecal occult blood tests


Health-related quality of life


Life years


National Patient Registry


Oslo University Hospital


Probabilistic sensitivity analysis


Patient performance status


Quality-adjusted life years


Willingness to pay

JEL Classification




We acknowledge the Department of Health, Nutrition and Management (HEL), The Faculty of Health Sciences, and Oslo and Akershus University College of Applied Sciences for funding Paal Joranger’s doctorate.

Compliance with ethical standards

Conflict of interest

All authors contributed to the work, are aware of, and agree to the submission. Any other person or body with an interest in the manuscript, such as our funders and employers, are also aware and agreed on the submission. Paal Joranger, Eline Aas, and Arne Oshaug declare no support from any organisation for the submitted work, no financial relationships in the previous 3 years with any organisations that might have an interest in the submitted work, and no other relationships or activities that could appear to have influenced the submitted work. In 2017, Geir Hoff received payment from Amgen Norway for giving a lecture at a medical conference. Halfdan Sorbye received Grants and personal fees from Merck, Roche, and Amgen and personal fees from Sanofi during the study. Arild Nesbakken received funding from Helse Sør-Øst for the clinical studies on colorectal cancer (OUS-Aker series). He is a member of a research group in OUS, which has patents on one diagnostic and two prognostic genetic tests for colorectal cancer. He received payment from Amgen Norway for giving a lecture at a medical conference 2018. Financial support for this study was provided entirely by the authors’ employers, which are listed above. The funding agreements ensured the authors’ independence in designing the study, interpreting the data, and writing and publishing the article. The authors declare that they have no competing interests.

Ethics approval and consent to participate

The observational study from 1993 to 2010, including 2049 patients diagnosed with CRC at Oslo University Hospital, was approved by the Regional Ethics Committee (Norway) for Medical Research (REK approval 1.2005.1629). The study with data collected from the National Patient Register (NPR) was approved by the Regional Ethics Committee (Norway). The reference number is S-02113 (2013/83).

Supplementary material

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Supplementary material 1 (PDF 216 kb)
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Supplementary material 2 (PDF 235 kb)
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Supplementary material 3 (PDF 316 kb)
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Supplementary material 4 (PDF 239 kb)
10198_2019_1130_MOESM5_ESM.pdf (415 kb)
Supplementary material 5 (PDF 415 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Norwegian University of Life SciencesÅsNorway
  2. 2.Faculty of Health SciencesOsloMet-Oslo Metropolitan UniversityOsloNorway
  3. 3.Department of Gastrointestinal SurgeryOslo University HospitalOsloNorway
  4. 4.K.G. Jebsen Colorectal Cancer Research Centre, Oslo University HospitalOsloNorway
  5. 5.Faculty of MedicineUniversity of OsloOsloNorway
  6. 6.Department of Oncology and Department of Clinical ScienceHaukeland University HospitalBergenNorway
  7. 7.University of BergenBergenNorway
  8. 8.Telemark HospitalSkienNorway
  9. 9.The Cancer Registry of NorwayOsloNorway
  10. 10.University of OsloOsloNorway
  11. 11.Institute of Health and Society, Department of Health Management and Health EconomicsUniversity of OsloOsloNorway

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