Using Incremental Cost-effectiveness Ratio to Analyze the Cost-utility Comparing Two Different Treatment Options for Colon Cancer in Chinese Mainland
Journal: Journal of Clinical Medicine Research DOI: 10.32629/jcmr.v6i3.4417
Abstract
Colorectal cancer exists as a major threat to human health. In mainland China, research analyzing the cost-utility of surgical treatments for patients with colorectal cancer is particularly scarce. The aim of this study is to fill the gap in study on cost-utility analysis of surgical treatment for colorectal cancer in mainland China. This study constructs a database by using secondary data obtained from searching published papers. The data is then analyzed and calculated to derive the Incremental Cost-Effectiveness Ratio (ICER) for laparoscopic surgery comparing with open surgery, and the ICER is then compared to the Willingness to Pay (WTP) threshold of Chinese patients. The results of the data analysis shows that the Quality-Adjusted Life Years (QALYs) for colorectal cancer patients in mainland China receiving laparoscopic surgery and open surgery are 6.85 years and 5.04 years respectively. The ICER for laparoscopic surgery compared to open surgery is 2866.54 China Yuan / QALY, which is much lower than the WTP threshold for treating advanced cancer in mainland China (i.e. 185753.06 China Yuan). The study finds that laparoscopic surgery has higher QALY and cost-utility in term of ICER comparing with open surgery when treating colorectal cancer in mainland China, making it a better treatment option. The findings of this study can serve as a guide for future patients, healthcare providers and policy-making departments.
Keywords
colorectal cancer, health technology assessment, quality-adjusted life years, markov model, willingness-to-pay
Full Text
PDF - Viewed/Downloaded: 1 TimesReferences
[1] Bray F, Jemal A, Grey N, Ferlay J, Forman D. Global cancer transitions according to the Human Development Index (2008–2030): a population-based study. The lancet oncology. 2012 Aug 1;13(8):790-801.
[2] Ge JB, Xu YJ, Wang C. Internal Medicine. 9th ed. Beijing: People's Medical Publishing House, 2018:381-383.
[3] Chen XP, Wang JP, Zhao JZ. Surgery. 9th ed. Beijing: People's Medical Publishing House, 2018:387-390.
[4] Martel G, Boushey RP. Laparoscopic colon surgery: past, present and future. Surgical Clinics. 2006 Aug 1;86(4):867-97.
[5] Ladwa N, Sajid MS, Pankhania NK, Sains P, Baig MK. Retraction techniques in laparoscopic colorectal surgery: a literature‐based review. Colorectal Disease. 2013 Aug;15(8):936-43.
[6] Qu R, Ma Y, Zhang Z, Fu W. Increasing burden of colorectal cancer in China. The Lancet Gastroenterology & Hepatology. 2022 Aug 1;7(8):700.
[7] Hu S, Tang S, Liu Y, Zhao Y, Escobar ML, De Ferranti D. Reform of how health care is paid for in China: challenges and opportunities. The Lancet. 2008 Nov 22;372(9652):1846-53.
[8] Bedirli A, Salman B, Yuksel O. Laparoscopic versus open surgery for colorectal cancer: a retrospective analysis of 163 patients in a single institution. Minimally Invasive Surgery. 2014;2014(1):530314.
[9] Ishibe A, Ota M, Fujii S, Suwa Y, Suzuki S, Suwa H, Momiyama M, et al. Midterm follow-up of a randomized trial of open surgery versus laparoscopic surgery in elderly patients with colorectal cancer. Surgical Endoscopy. 2017 Oct;31:3890-7.
[10] Devoto L, Celentano V, Cohen R, Khan J, Chand M. Colorectal cancer surgery in the very elderly patient: a systematic review of laparoscopic versus open colorectal resection. International journal of colorectal disease. 2017 Sep;32:1237-42.
[11] Quintana JM, Antón-Ladisla A, González N, Lázaro S, Baré M, de Larrea NF, Redondo M, et al. Outcomes of open versus laparoscopic surgery in patients with colon cancer. European Journal of Surgical Oncology. 2018 Sep 1;44(9):1344-53.
[12] Ustuner MA, Deniz A, Simsek A. Laparoscopic versus open surgery in colorectal cancer: Is laparoscopy safe enough?. Age (Years). 2022;60(1182):64-88.
[13] Murray AC, Lourenco T, De Verteuil R, Hernández RA, Fraser MF, McKinley AJ, Krukowski ZH, et al. Clinical effectiveness and cost-effectiveness of laparoscopic surgery for colorectal cancer: systematic reviews and economic evaluation. 2006.
[14] Gehrman J, Björholt I, Angenete E, Andersson J, Bonjer J, Haglind E. Health economic analysis of costs of laparoscopic and open surgery for rectal cancer within a randomized trial (COLOR II). Surgical endoscopy. 2017 Mar;31:1225-34.
[15] Silva-Illanes N, Espinoza M. Critical analysis of Markov models used for the economic evaluation of colorectal cancer screening: a systematic review. Value in Health. 2018 Jul 1;21(7):858-73.
[16] Mar J, Anton-Ladislao A, Ibarrondo O, Arrospide A, Lázaro-Aramburu S, Gonzalez N, Bare M, et al. Stage-and age-adjusted cost-effectiveness analysis of laparoscopic surgery in rectal cancer. Surgical Endoscopy. 2020 Mar;34:1167-76.
[17] Chen ST, Wu MC, Hsu TC, Yen DW, Chang CN, Hsu WT, Wang CC, et al. Comparison of outcome and cost among open, laparoscopic, and robotic surgical treatments for rectal cancer: a propensity score matched analysis of nationwide inpatient sample data. Journal of surgical oncology. 2018 Mar;117(3):497-505.
[18] Wang KX, Li SP, Dou L, Liu SX, Shi Z, Wang RX. Systematic Review of Economic Evaluation of Targeted Drugs for Colorectal Cancer Treatment in China. Chinese Journal of Modern Applied Pharmacy. 2023;12:1621-1629.
[19] Gao HL, Zhao WF, Lu QW, Sun XY, Lv LB, Fan JQ. Health Economics Evaluation on Hospital-Based Colorectal Cancer Screening Strategies. Chinese Health Economics. 2023;2:69-72.
[20] Wang DY, Lou XB, Wang CG, Ye YX, Lin L. Comparative Analysis on the Clinical Effects of Laparoscopic and Open Surgery on Colorectal Cancer. Progress in Modern Biomedicine. 2014;14(29):5702-5704.
[21] Shu YX. Clinical Comparative Study and Health Economics Evaluation of Laparoscopic Radical Resection and Traditional Open Surgery for Colorectal Cancer [Doctoral dissertation]. Kunming Medical University; 2018.
[22] Jia SH, Dong ZH, Sun LH, Peng XC. A study of the economic burden of disease in Chinese colon cancer patients. Modern Business Trade Industry. 2019;16:82-83.
[23] Ren Y, Chen X, Chen KD, Ma AX. Economic Burden of Colorectal Cancer in China: A Systematic Review. China Journal of Pharmaceutical Economics. 2022;07:5-11.
[24] Muennig P. Cost-effectiveness analysis in health: a practical approach. 2nd ed. San Francisco: Jossey-Bass, 2008:7-28, 92-128.
[25] Roberge R, Berthelot JM, Wolfson M. The Health Utility Index: Measuring health differences in Ontario by socioeconomic status. Health Reports. 1995 Jan 1;7(2):25-32.
[26] Chen JL, Huang XL, Sun R, Li J, Gao W. Research progress on health-related quality of life scales for colorectal cancer patients. Chinese Evidence-Based Nursing. 2025;7:1313-1318.
[27] Cui M, Liu S. Meta-analysis of the effect of laparoscopic surgery and open surgery on long-term quality of life in patients with colorectal cancer. Medicine. 2023 Sep 8;102(36):e34922.
[28] Brazier JE, Harper R, Jones NM, O'Cathain A, Thomas KJ, Usherwood T, Westlake L. Validating the SF-36 health survey questionnaire: new outcome measure for primary care. British medical journal. 1992 Jul 18;305(6846):160-4.
[29] Herdman M, Gudex C, Lloyd A, Janssen MF, Kind P, Parkin D, Bonsel G, Badia X. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Quality of life research. 2011 Dec;20:1727-36.
[30] Ward WL, Hahn EA, Mo F, Hernandez L, Tulsky DS, Cella D. Reliability and validity of the Functional Assessment of Cancer Therapy-Colorectal (FACT-C) quality of life instrument. Quality of Life Research. 1999 May;8:181-95.
[31] Sprangers MA, Te Velde A, Aaronson NK, for Research EO. The construction and testing of the EORTC colorectal cancer-specific quality of life questionnaire module (QLQ-CR38). European journal of cancer. 1999 Feb 1;35(2):238-47.
[32] Chi YL, Blecher M, Chalkidou K, Culyer A, Claxton K, Edoka I, Glassman A, Kreif N, Jones I, Mirelman AJ, Nadjib M. What next after GDP-based cost-effectiveness thresholds?. Gates open research. 2020 Nov 30;4:176.
[33] Nimdet K, Chaiyakunapruk N, Vichansavakul K, Ngorsuraches S. A systematic review of studies eliciting willingness-to-pay per quality-adjusted life year: does it justify CE threshold?. PloS one. 2015 Apr 9;10(4):e0122760.
[34] Ye Z, Abduhilil R, Huang J, Sun L. Willingness to pay for one additional quality adjusted life year: a population based survey from China. Applied health economics and health policy. 2022 Nov;20(6):893-904.
[35] Xu L, Chen M, Angell B, Jiang Y, Howard K, Jan S, Si L. Establishing cost-effectiveness threshold in China: a community survey of willingness to pay for a healthy life year. BMJ Global Health. 2024 Jan 9;9(1).
[36] Yin XY, Zhou N, Yang XL, Sun ZY, Bao YH, Wang SS, Han K, Long J, Zhao M, Li HW, Li RR. Health economic evaluation of minimally invasive surgery in treatment of digestive tract cancers: a Meta-analysis. Chinese Journal of Epidemiology. 2025 Jan 10;46(1):154-65.
[37] National Bureau of Statistics of China. Consumer price index [Statistical data]. National Data. 2025. Available from: https://data.stats.gov.cn/easyquery.htm?cn=C01&zb=A0902&sj=2023
[38] Tang Y, Lu XM, Tong Q, Wang GB, Tao KX, Niu YF. Laparoscopic versus open surgery in treating colorectal cancer: a comparative study on postoperative incidence of anastomotic leakage and clinical effectiveness. Journal of Clinical Surgery. 2018;01:39-42.
[39] National Bureau of Statistics of China. Income per capita [Statistical data]. National Data. 2025. Available from: https://data.stats.gov.cn/easyquery.htm?cn=C01&zb=A0A01&sj=2024
[40] Zhu Z, Wang KJ, Orangio GR, Han JY, Lu B, Zhou ZQ, Gao W, Fu CG. Clinical efficacy and quality of life after transrectal natural orifice specimen extraction for the treatment of middle and upper rectal cancer. Journal of gastrointestinal oncology. 2020 Apr;11(2):260.
[41] Chen K, Cao G, Chen B, Wang M, Xu X, Cai W, Xu Y, Xiong M. Laparoscopic versus open surgery for rectal cancer: a meta-analysis of classic randomized controlled trials and high-quality nonrandomized studies in the last 5 years. International journal of surgery. 2017 Mar 1;39:1-0.
[42] National Bureau of Statistics of China. Average life expectancy of China [Statistical data]. National Data. 2025. Available from: https://data.stats.gov.cn/easyquery.htm?cn=C01&zb=A0304&sj=2024
[43] Chen W, Zheng R, Baade PD, Zhang S, Zeng H, Bray F, Jemal A, Yu XQ, He J. Cancer statistics in China, 2015. CA: a cancer journal for clinicians. 2016 Mar;66(2):115-32.
[44] Wan DS. Epidemiology and Prevention of Colorectal Cancer. Chinese Journal of Surgery of Integrated Traditional and Western Medicine. 2011;17(1):5.
[45] Guo JP, Zhu L, Su YX, Wang XL, Reshat M. Research on the Risk Factors and Epidemiological Characteristics of Colorectal Cancer. The Practical Journal of Cancer. 2015;04:544-546.
[46] Xu L, Chen M, Angell B, Jiang Y, Howard K, Jan S, Si L. Establishing cost-effectiveness threshold in China: a community survey of willingness to pay for a healthy life year. BMJ Global Health. 2024 Jan 9;9(1).
[47] National Bureau of Statistics of China. Annual GDP per capita of China [Statistical data]. National Data. 2025. Available from: https://data.stats.gov.cn/easyquery.htm?cn=C01&zb=A0201&sj=2024
[2] Ge JB, Xu YJ, Wang C. Internal Medicine. 9th ed. Beijing: People's Medical Publishing House, 2018:381-383.
[3] Chen XP, Wang JP, Zhao JZ. Surgery. 9th ed. Beijing: People's Medical Publishing House, 2018:387-390.
[4] Martel G, Boushey RP. Laparoscopic colon surgery: past, present and future. Surgical Clinics. 2006 Aug 1;86(4):867-97.
[5] Ladwa N, Sajid MS, Pankhania NK, Sains P, Baig MK. Retraction techniques in laparoscopic colorectal surgery: a literature‐based review. Colorectal Disease. 2013 Aug;15(8):936-43.
[6] Qu R, Ma Y, Zhang Z, Fu W. Increasing burden of colorectal cancer in China. The Lancet Gastroenterology & Hepatology. 2022 Aug 1;7(8):700.
[7] Hu S, Tang S, Liu Y, Zhao Y, Escobar ML, De Ferranti D. Reform of how health care is paid for in China: challenges and opportunities. The Lancet. 2008 Nov 22;372(9652):1846-53.
[8] Bedirli A, Salman B, Yuksel O. Laparoscopic versus open surgery for colorectal cancer: a retrospective analysis of 163 patients in a single institution. Minimally Invasive Surgery. 2014;2014(1):530314.
[9] Ishibe A, Ota M, Fujii S, Suwa Y, Suzuki S, Suwa H, Momiyama M, et al. Midterm follow-up of a randomized trial of open surgery versus laparoscopic surgery in elderly patients with colorectal cancer. Surgical Endoscopy. 2017 Oct;31:3890-7.
[10] Devoto L, Celentano V, Cohen R, Khan J, Chand M. Colorectal cancer surgery in the very elderly patient: a systematic review of laparoscopic versus open colorectal resection. International journal of colorectal disease. 2017 Sep;32:1237-42.
[11] Quintana JM, Antón-Ladisla A, González N, Lázaro S, Baré M, de Larrea NF, Redondo M, et al. Outcomes of open versus laparoscopic surgery in patients with colon cancer. European Journal of Surgical Oncology. 2018 Sep 1;44(9):1344-53.
[12] Ustuner MA, Deniz A, Simsek A. Laparoscopic versus open surgery in colorectal cancer: Is laparoscopy safe enough?. Age (Years). 2022;60(1182):64-88.
[13] Murray AC, Lourenco T, De Verteuil R, Hernández RA, Fraser MF, McKinley AJ, Krukowski ZH, et al. Clinical effectiveness and cost-effectiveness of laparoscopic surgery for colorectal cancer: systematic reviews and economic evaluation. 2006.
[14] Gehrman J, Björholt I, Angenete E, Andersson J, Bonjer J, Haglind E. Health economic analysis of costs of laparoscopic and open surgery for rectal cancer within a randomized trial (COLOR II). Surgical endoscopy. 2017 Mar;31:1225-34.
[15] Silva-Illanes N, Espinoza M. Critical analysis of Markov models used for the economic evaluation of colorectal cancer screening: a systematic review. Value in Health. 2018 Jul 1;21(7):858-73.
[16] Mar J, Anton-Ladislao A, Ibarrondo O, Arrospide A, Lázaro-Aramburu S, Gonzalez N, Bare M, et al. Stage-and age-adjusted cost-effectiveness analysis of laparoscopic surgery in rectal cancer. Surgical Endoscopy. 2020 Mar;34:1167-76.
[17] Chen ST, Wu MC, Hsu TC, Yen DW, Chang CN, Hsu WT, Wang CC, et al. Comparison of outcome and cost among open, laparoscopic, and robotic surgical treatments for rectal cancer: a propensity score matched analysis of nationwide inpatient sample data. Journal of surgical oncology. 2018 Mar;117(3):497-505.
[18] Wang KX, Li SP, Dou L, Liu SX, Shi Z, Wang RX. Systematic Review of Economic Evaluation of Targeted Drugs for Colorectal Cancer Treatment in China. Chinese Journal of Modern Applied Pharmacy. 2023;12:1621-1629.
[19] Gao HL, Zhao WF, Lu QW, Sun XY, Lv LB, Fan JQ. Health Economics Evaluation on Hospital-Based Colorectal Cancer Screening Strategies. Chinese Health Economics. 2023;2:69-72.
[20] Wang DY, Lou XB, Wang CG, Ye YX, Lin L. Comparative Analysis on the Clinical Effects of Laparoscopic and Open Surgery on Colorectal Cancer. Progress in Modern Biomedicine. 2014;14(29):5702-5704.
[21] Shu YX. Clinical Comparative Study and Health Economics Evaluation of Laparoscopic Radical Resection and Traditional Open Surgery for Colorectal Cancer [Doctoral dissertation]. Kunming Medical University; 2018.
[22] Jia SH, Dong ZH, Sun LH, Peng XC. A study of the economic burden of disease in Chinese colon cancer patients. Modern Business Trade Industry. 2019;16:82-83.
[23] Ren Y, Chen X, Chen KD, Ma AX. Economic Burden of Colorectal Cancer in China: A Systematic Review. China Journal of Pharmaceutical Economics. 2022;07:5-11.
[24] Muennig P. Cost-effectiveness analysis in health: a practical approach. 2nd ed. San Francisco: Jossey-Bass, 2008:7-28, 92-128.
[25] Roberge R, Berthelot JM, Wolfson M. The Health Utility Index: Measuring health differences in Ontario by socioeconomic status. Health Reports. 1995 Jan 1;7(2):25-32.
[26] Chen JL, Huang XL, Sun R, Li J, Gao W. Research progress on health-related quality of life scales for colorectal cancer patients. Chinese Evidence-Based Nursing. 2025;7:1313-1318.
[27] Cui M, Liu S. Meta-analysis of the effect of laparoscopic surgery and open surgery on long-term quality of life in patients with colorectal cancer. Medicine. 2023 Sep 8;102(36):e34922.
[28] Brazier JE, Harper R, Jones NM, O'Cathain A, Thomas KJ, Usherwood T, Westlake L. Validating the SF-36 health survey questionnaire: new outcome measure for primary care. British medical journal. 1992 Jul 18;305(6846):160-4.
[29] Herdman M, Gudex C, Lloyd A, Janssen MF, Kind P, Parkin D, Bonsel G, Badia X. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Quality of life research. 2011 Dec;20:1727-36.
[30] Ward WL, Hahn EA, Mo F, Hernandez L, Tulsky DS, Cella D. Reliability and validity of the Functional Assessment of Cancer Therapy-Colorectal (FACT-C) quality of life instrument. Quality of Life Research. 1999 May;8:181-95.
[31] Sprangers MA, Te Velde A, Aaronson NK, for Research EO. The construction and testing of the EORTC colorectal cancer-specific quality of life questionnaire module (QLQ-CR38). European journal of cancer. 1999 Feb 1;35(2):238-47.
[32] Chi YL, Blecher M, Chalkidou K, Culyer A, Claxton K, Edoka I, Glassman A, Kreif N, Jones I, Mirelman AJ, Nadjib M. What next after GDP-based cost-effectiveness thresholds?. Gates open research. 2020 Nov 30;4:176.
[33] Nimdet K, Chaiyakunapruk N, Vichansavakul K, Ngorsuraches S. A systematic review of studies eliciting willingness-to-pay per quality-adjusted life year: does it justify CE threshold?. PloS one. 2015 Apr 9;10(4):e0122760.
[34] Ye Z, Abduhilil R, Huang J, Sun L. Willingness to pay for one additional quality adjusted life year: a population based survey from China. Applied health economics and health policy. 2022 Nov;20(6):893-904.
[35] Xu L, Chen M, Angell B, Jiang Y, Howard K, Jan S, Si L. Establishing cost-effectiveness threshold in China: a community survey of willingness to pay for a healthy life year. BMJ Global Health. 2024 Jan 9;9(1).
[36] Yin XY, Zhou N, Yang XL, Sun ZY, Bao YH, Wang SS, Han K, Long J, Zhao M, Li HW, Li RR. Health economic evaluation of minimally invasive surgery in treatment of digestive tract cancers: a Meta-analysis. Chinese Journal of Epidemiology. 2025 Jan 10;46(1):154-65.
[37] National Bureau of Statistics of China. Consumer price index [Statistical data]. National Data. 2025. Available from: https://data.stats.gov.cn/easyquery.htm?cn=C01&zb=A0902&sj=2023
[38] Tang Y, Lu XM, Tong Q, Wang GB, Tao KX, Niu YF. Laparoscopic versus open surgery in treating colorectal cancer: a comparative study on postoperative incidence of anastomotic leakage and clinical effectiveness. Journal of Clinical Surgery. 2018;01:39-42.
[39] National Bureau of Statistics of China. Income per capita [Statistical data]. National Data. 2025. Available from: https://data.stats.gov.cn/easyquery.htm?cn=C01&zb=A0A01&sj=2024
[40] Zhu Z, Wang KJ, Orangio GR, Han JY, Lu B, Zhou ZQ, Gao W, Fu CG. Clinical efficacy and quality of life after transrectal natural orifice specimen extraction for the treatment of middle and upper rectal cancer. Journal of gastrointestinal oncology. 2020 Apr;11(2):260.
[41] Chen K, Cao G, Chen B, Wang M, Xu X, Cai W, Xu Y, Xiong M. Laparoscopic versus open surgery for rectal cancer: a meta-analysis of classic randomized controlled trials and high-quality nonrandomized studies in the last 5 years. International journal of surgery. 2017 Mar 1;39:1-0.
[42] National Bureau of Statistics of China. Average life expectancy of China [Statistical data]. National Data. 2025. Available from: https://data.stats.gov.cn/easyquery.htm?cn=C01&zb=A0304&sj=2024
[43] Chen W, Zheng R, Baade PD, Zhang S, Zeng H, Bray F, Jemal A, Yu XQ, He J. Cancer statistics in China, 2015. CA: a cancer journal for clinicians. 2016 Mar;66(2):115-32.
[44] Wan DS. Epidemiology and Prevention of Colorectal Cancer. Chinese Journal of Surgery of Integrated Traditional and Western Medicine. 2011;17(1):5.
[45] Guo JP, Zhu L, Su YX, Wang XL, Reshat M. Research on the Risk Factors and Epidemiological Characteristics of Colorectal Cancer. The Practical Journal of Cancer. 2015;04:544-546.
[46] Xu L, Chen M, Angell B, Jiang Y, Howard K, Jan S, Si L. Establishing cost-effectiveness threshold in China: a community survey of willingness to pay for a healthy life year. BMJ Global Health. 2024 Jan 9;9(1).
[47] National Bureau of Statistics of China. Annual GDP per capita of China [Statistical data]. National Data. 2025. Available from: https://data.stats.gov.cn/easyquery.htm?cn=C01&zb=A0201&sj=2024
Copyright © 2025 Tianyi Huang
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License