Treatment pathways and associated costs of metastatic colorectal cancer in Greece
Objectives: Colorectal cancer (CRC) is the second leading cause of cancer in Europe, with 1.931.590 people newly
diagnosed in 2020. The purpose of this study is the investigation of treatment options and healthcare resource meta-
static CRC (mCRC) in Greece.
Methods: This study is based on the information collected in November 2020 by an expert panel comprising of
6 medical oncologists from major public and private centers around Greece. A 3-round survey was undertaken,
according to Delphi method. The treatment phases studied were: pre-progression; disease progression and terminal
care. Pharmaceutical costs and resource utilization data were considered from the perspective of the Greek National
Services Organization (EOPYY). RESULTS: Experts agreed that the anticipated prevalence of RAS mutation in mCRC is
47% (30% RAS/BRAF WT Left, 17% RAS/BRAF WT Right); 8% BRAF while, MSI-H/dMMR are found in 5% of mCRC tumors.
Based on mutational status, 74.8% of patients receive biological targeted therapies in combination with fluoropy –
rimidine/based combination chemotherapy, as 1st line treatment, and 25.2% combination chemotherapy alone. At
2nd line, 58.6% of patients receive biological targeted therapies in combination with chemotherapy, 25.4% immuno-
therapy, 11% combination chemotherapy and 5% biological targeted therapies. At 3rd line 56% of patients receive
combination chemotherapy, 28% biological targeted therapies, 10% biological targeted therapies in combination
with chemotherapy and 6% immunotherapy. The weighted annual cost (pharmaceuticals and resource use cost) in
1st line per mCRC patient was calculated at €28,407, in 2nd line €33,568, in 3rd line €25,550. The annual cost beyond
3rd line per patient regardless mutation was €19,501 per mCRC patient.
Conclusions: mCRC is a societal challenge for healthcare systems as the treatment is more prolonged but expand
patients’ survival. Thus, reimbursement decisions should be based not just on the cost of the treatment, but on the
magnitude of the benefit of its treatment on patients’ survival and quality of life.
Ioannis Sougklakos, Elias Athanasiadis, Ioannis Boukovinas, Michalis Karamouzis, Aggelos Koutras, Paulos Papakotoulas, Dimitra Latsou, Magda Hatzikou, Eugena Stamuli, Athanasios Balasopoulos and Aggelos Sideris
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