In most advanced countries, cancer-related expenditure accounts for a growing portion of resources due to changes in risk factors, the availability of more advanced diagnostic procedures and specific treatments, and the aging of the population. In Italy, 2% of the population lives with a cancer diagnosis, and this percentage is set to increase. It is important to be able to measure and project the impact both in terms of people and public spending for intervention planning purposes. The Epicost project, funded by the Ministry of Health (CCM 2014), aims to: 1. describe the diagnostic-therapeutic-care pathways and the economic resources allocated to cancer patients in certain areas covered by population-based Cancer Registries (CR); 2. provide forecasts on the number of patients and related costs according to different scenarios; 3. evaluate, at the regional level, the expected variation in healthcare spending in relation to specific preventive interventions (e.g., screening programs) and therapeutic interventions (e.g., use of new high-cost biological drugs) and to demographic dynamics.

Clinical and demographic information on cancer patients provided by 8 population-based Cancer Registries is linked at the individual level with economic information from administrative sources (hospitalizations, specialist services, medications).

The distribution of patients and their associated economic resources is estimated throughout the entire course of the disease, identified by three clinically relevant phases: the initial phase (one year after diagnosis), the intermediate phase (between the initial and final phases), and the final phase (one year before death). Specific expenditure profiles are constructed for all variables that can influence the care pathway.

Dynamic micro-simulation models are used to project expenditure estimates both geographically and over time.

Software is being developed for managing the linkage between CR data and administrative data; identifying diagnosis and treatment profiles; and estimating the number of prevalent cases and expenditure profiles by disease phase.

Research products:

• Francisci, Guzzinati, Mezzetti, Crocetti, Giusti, Miccinesi, Paci, Angiolini, Gigli (2013). Cost profiles of colorectal cancer patients in Italy based on individual patterns of care. BMC Cancer, 13: 329.
• Gigli, Warren, Yabroff, Francisci, Stedman, Guzzinati, Giusti, Miccinesi, Crocetti, Angiolini, Mariotto (2013). Initial Treatment for Newly Diagnosed Elderly Colorectal Cancer Patients: Patterns of Care in Italy and the United States. J Natl Cancer Inst Monogr 2013.