In most advanced countries, expenditure on cancer commits an increasing 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 diagnosis of cancer and this percentage is destined to increase. It is important to be able to measure and project the impact both in terms of people and public spending, in order to plan interventions. The Epicost project, funded by the Ministry of Health (CCM 2014), aims to: 1. describe the diagnostic-therapeutic-assistance paths and the economic resources allocated to cancer patients in some areas covered by population cancer registries (RT); 2. make forecasts on the number of patients and related costs, according to different scenarios; 3. assess, at a regional level, the expected variation in healthcare expenditure in relation to specific preventive (eg screening programs) and therapeutic interventions (eg use of new high-cost biological drugs) and demographic dynamics.

Clinical and demographic information on cancer patients provided by 8 Population Cancer Registries are linked on an individual level with economic information from administrative sources (hospital admissions, specialist services, drugs).

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

Dynamic micro-simulation models are used which make it possible to project, both geographically and temporally, the estimates of expenditure.

A software is developed aimed at managing the linkage between RT data and administrative data; identification of the diagnosis and treatment profiles; estimate of the number of prevalent cases and of the 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.