{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T20:18:42Z","timestamp":1767212322045,"version":"build-2065373602"},"reference-count":59,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,4,3]],"date-time":"2025-04-03T00:00:00Z","timestamp":1743638400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of KwaZulu-Natal, College of Health Science Scholarship"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Colorectal cancer burden is a threat to health systems in several countries. As the cost of diagnosing, treating, and managing this cancer is unknown in Antigua and Barbuda, this study aimed to estimate its direct medical cost in this country. We used the prevalence-based cost-of-illness methodology to study data on patients diagnosed with colorectal cancer between 2017 and 2021. Data record abstraction was carried out to determine the five-year prevalence, and a top-down and bottom-up approach was employed to estimate the direct medical costs for colorectal cancer care components. All costs were computed at 2021 price levels and are reported in United States dollars. The total annual direct medical costs for colorectal cancer were estimated at USD 1.14 million (ranging between USD 0.85 million and USD 1.42 million). Major cost drivers were treatment (USD 613,650.01) and post-treatment side-effects care (USD 402,234.50). The overall estimated direct medical unit costs were USD 139,295.58, with the main drivers being surgery (USD 43,467.10), other complications of treatment (USD 28,469.21), and immunotherapy (USD 19,200.00). This study provides evidence of the economic burden of colorectal cancer in Antigua and Barbuda. The estimates of annual direct medical costs are substantial. Our findings could help in the development of health policy and aid in resource allocation related to local colorectal cancer management.<\/jats:p>","DOI":"10.3390\/ijerph22040552","type":"journal-article","created":{"date-parts":[[2025,4,3]],"date-time":"2025-04-03T04:33:43Z","timestamp":1743654823000},"page":"552","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Analysis of the Direct Medical Costs of Colorectal Cancer in Antigua and Barbuda: A Prevalence-Based Cost-of-Illness Study"],"prefix":"10.3390","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4714-7320","authenticated-orcid":false,"given":"Andre A. N.","family":"Bovell","sequence":"first","affiliation":[{"name":"Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4000, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2151-1251","authenticated-orcid":false,"given":"Jabulani","family":"Ncayiyana","sequence":"additional","affiliation":[{"name":"Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4000, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9435-3488","authenticated-orcid":false,"given":"Themba G.","family":"Ginindza","sequence":"additional","affiliation":[{"name":"Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4000, South Africa"},{"name":"Cancer & Infectious Diseases Epidemiology Research Unit (CIDERU), College of Health Sciences, University of KwaZulu-Natal, Durban 4000, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"229","DOI":"10.3322\/caac.21834","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"209","DOI":"10.3322\/caac.21660","article-title":"Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J. Clin."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"967","DOI":"10.2147\/CIA.S109285","article-title":"Colorectal cancer development and advances in screening","volume":"11","author":"Balchen","year":"2016","journal-title":"Clin. Interv. Aging"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"REACCT Collaborative, Zaborowski, A.M., Abdile, A., Adamina, M., Aigner, F., D\u2019allens, L., Allmer, C., \u00c1lvarez, A., Anula, R., and Andric, M. (2021). Characteristics of Early-Onset vs Late-Onset Colorectal Cancer: A Review. JAMA Surg., 156, 865\u2013874.","DOI":"10.1001\/jamasurg.2021.2380"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1093\/jnci\/93.8.583","article-title":"Guidelines 2000 for Colon and Rectal Cancer Surgery","volume":"93","author":"Nelson","year":"2001","journal-title":"JNCI J. Natl. Cancer Inst."},{"key":"ref_6","first-page":"75","article-title":"Colorectal cancer- overview article","volume":"2014","author":"Gunnlaugsson","year":"2014","journal-title":"L\u00e6knabla\u00f0i\u00f0"},{"key":"ref_7","first-page":"103","article-title":"Colorectal cancer\u2014Clinical and morphological aspects","volume":"55","author":"Vasile","year":"2014","journal-title":"Rom. J. Morphol. Embryol."},{"key":"ref_8","unstructured":"Beaulieu, N., Bloom, D.E., Reddy Bloom, L., and Stein, R.M. (2022, May 26). Breakaway: The Global Burden of Cancer-Challenges and Opportunities. A Report from the Economist Intelligence Unit. Available online: https:\/\/Api.Semanticscholar.Org\/CorpusID:17314834:n.d."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1097\/MLR.0b013e3182726c13","article-title":"Cost comparisons and methodological heterogeneity in cost-of-illness studies: The example of colorectal cancer","volume":"51","author":"Hanly","year":"2013","journal-title":"Med. Care"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"327","DOI":"10.3350\/cmh.2014.20.4.327","article-title":"Cost-of-illness studies: Concepts, scopes, and methods","volume":"20","author":"Jo","year":"2014","journal-title":"Clin. Mol. Hepatol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"84","DOI":"10.3961\/jpmph.2014.47.2.84","article-title":"Economic Burden of Colorectal Cancer in Korea","volume":"47","author":"Byun","year":"2014","journal-title":"J. Prev. Med. Public Health"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"768","DOI":"10.14196\/mjiri.31.115","article-title":"Economic burden of colorectal cancer in Iran in 2012","volume":"31","author":"Vahdatimanesh","year":"2017","journal-title":"Med. J. Islam. Repub. Iran"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Rezende, L.F.M., Ferrari, G., Bahia, L.R., Rosa, R.D.S., da Rosa, M.Q.M., de Souza, R.C., Lee, D.H., Giovannucci, E., and Eluf-Neto, J. (2021). Economic burden of colorectal and breast cancers attributable to lack of physical activity in Brazil. BMC Public Health, 21.","DOI":"10.1186\/s12889-021-11221-w"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1007\/s40273-013-0055-4","article-title":"Cost of illness in colorectal cancer: An international review","volume":"31","author":"Kriza","year":"2013","journal-title":"Pharmacoeconomics"},{"key":"ref_15","unstructured":"Statistics Division Ministry of Finance and Corporate Governance (2024, January 29). Population Projections by Age Group, Annual 1991 to 2026. Statistics Division 2023, Available online: https:\/\/statistics.gov.ag\/subjects\/population-and-demography\/population-projections-by-age-group-annual-1991-2026\/."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Bovell, A.A.N., Ngcamphalala, C., Abbott, D., Ncayiyana, J., and Ginindza, T.G. (2024). Cost Analysis Related to Diagnosis, Treatment and Management of Cervical Cancer in Antigua and Barbuda: A Prevalence-Based Cost-of-Illness Study. Int. J. Environ. Res. Public Health, 21.","DOI":"10.3390\/ijerph21121685"},{"key":"ref_17","unstructured":"Commonwealth Network (2023, September 22). Find Health and Medical Expertise in Antigua and Barbuda. Health and Medical Organizations in Antigua and Barbuda. Available online: https:\/\/www.commonwealthofnations.org\/sectors-antigua_and_barbuda\/business\/health_and_medical\/."},{"key":"ref_18","unstructured":"Communications and Marketing Department Medical Benefits Scheme (2023, September 22). About Us. Medical Benefits Scheme, Available online: https:\/\/www.mbs.gov.ag\/v2\/about\/."},{"key":"ref_19","unstructured":"Pan American Health Organization (2023, May 26). Leading Causes of Mortality and Health Loss at Regional, Subregional, and Country Levels in the Region of the Americas, 2000\u20132019. Pan American Health Organization. Available online: https:\/\/www.paho.org\/en\/enlace\/leading-causes-death-and-disability."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/j.respe.2016.11.002","article-title":"Trends in colorectal cancer in the Caribbean: A population-based study in Martinique, 1982\u20132011","volume":"65","author":"Joachim","year":"2017","journal-title":"Rev. Epidemiol Sante Publique"},{"key":"ref_21","unstructured":"Statistics Division Ministry of Finance and Corporate Governance (2023, September 22). Travel and Tourism. Antigua and Barbuda Statistics Division 2023, Available online: https:\/\/statistics.gov.ag\/subjects\/travel-and-tourism\/."},{"key":"ref_22","unstructured":"Eastern Caribbean Central Bank (ECCB) (2023, September 22). Currency. Eastern Caribbean Central Bank 2023. Available online: https:\/\/www.eccb-centralbank.org\/currency."},{"key":"ref_23","unstructured":"Eastern Caribbean Central Bank (ECCB) (2023, September 22). About the E.C.C.B. Eastern Caribbean Central Bank 2023. Available online: https:\/\/www.eccb-centralbank.org\/about-the-eccb."},{"key":"ref_24","unstructured":"The World Bank (2023, September 22). Human Capital Index (HCI), Antigua and Barbuda. World Bank IBRD-IDA. Available online: https:\/\/data.worldbank.org\/indicator\/HD.HCI.OVRL.UB?locations=AG."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Bovell, A.A.N., Ramaliba, T., Goodwin, S.O., Phillip, J.C., Ncayiyana, J., and Ginindza, T.G. (2025). Incidence, trends and patterns of female breast, cervical, colorectal and prostate cancers in Antigua and Barbuda, 2017\u20132021, a retrospective study. BMC Cancer, 25.","DOI":"10.1186\/s12885-025-13459-8"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Bovell, A.A.N., Ngcamphalala, C., Rhudd, A., Ncayiyana, J., and Ginindza, T.G. (2024). The Economic Burden of Prostate Cancer in Antigua and Barbuda: A Prevalence-Based Cost-of-Illness Analysis from the Healthcare Provider Perspective. Int. J. Environ. Res. Public Health, 21.","DOI":"10.3390\/ijerph21111527"},{"key":"ref_27","unstructured":"World Health Organization (2023, September 16). International Classification of Diseases, 10th Version (ICD-10). World Health Organization. Available online: https:\/\/icd.who.int\/browse10\/2019\/en#\/C15-C26."},{"key":"ref_28","unstructured":"World Health Organization (2017). Cancer Prevention and Control in the Context of an Integrated Approach, World Health Assembly 70; World Health Organization. Available online: https:\/\/iris.who.int\/handle\/10665\/275676."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"874","DOI":"10.6004\/jnccn.2018.0061","article-title":"Rectal Cancer, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology","volume":"16","author":"Benson","year":"2018","journal-title":"J. Natl. Compr. Cancer Netw."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"329","DOI":"10.6004\/jnccn.2021.0012","article-title":"Colon Cancer, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology","volume":"19","author":"Benson","year":"2021","journal-title":"J. Natl. Compr. Cancer Netw."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e18","DOI":"10.26633\/RPSP.2022.18","article-title":"Colorectal cancer in an Eastern Caribbean nation: Are we missing an opportunity for secondary prevention?","volume":"46","author":"Cawich","year":"2022","journal-title":"Rev. Panam. Salud Publica"},{"key":"ref_32","unstructured":"International Agency for Research on Cancer (2024, December 07). CanScreen 5; Country Fact Sheet: Antigua and Barbuda, Colorectal Cancer Screening Programme. World Health Organ. Available online: https:\/\/canscreen5.iarc.fr\/?page=countryfactsheetcrc&q=ATG&rc=."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Cavalli, F., Kaye, S.B., Hansen, H.H., Armitage, J.O., and Piccart-Gebhart, M. (2009). Gastrointestinal Cancers. Textbook of Medical Oncology, Taylor & Francis Group.","DOI":"10.3109\/9780203092897"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"ed112","DOI":"10.3332\/ecancer.2021.ed112","article-title":"The current state of prostate cancer in Antigua & Barbuda\u20142021","volume":"15","author":"Rhudd","year":"2021","journal-title":"Ecancermedicalscience"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1080\/13696998.2020.1717500","article-title":"Treatment patterns and direct medical costs of metastatic colorectal cancer patients: A retrospective study of electronic medical records from urban China","volume":"23","author":"Shen","year":"2020","journal-title":"J. Med. Econ."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Ginindza, T.G., Sartorius, B., Dlamini, X., and \u00d6stensson, E. (2017). Cost analysis of Human Papillomavirus-related cervical diseases and genital warts in Swaziland. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0177762"},{"key":"ref_37","unstructured":"Government of Antigua and Barbuda (2023, September 22). Medical Benefits Act, 2010 (No. 4 of 2010); St. John\u2019s: 2010, Available online: https:\/\/www.mbs.gov.ag\/v2\/mdocs-posts\/m-b-s-act-and-regulations\/."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"653","DOI":"10.2165\/11588380-000000000-00000","article-title":"Cost-of-illness studies: A guide to critical evaluation","volume":"29","author":"Larg","year":"2011","journal-title":"Pharmacoeconomics"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e2400066","DOI":"10.1200\/GO.24.00066","article-title":"Toward a Framework to Assess the Financial and Economic Burden of Cervical Cancer in Low- and Middle-Income Countries: A Systematic Review","volume":"10","author":"Fuady","year":"2024","journal-title":"JCO Glob. Oncol."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Ngcamphalala, C., \u00d6stensson, E., and Ginindza, T.G. (2022). The economic burden of prostate cancer in Eswatini. BMC Health Serv. Res., 22.","DOI":"10.1186\/s12913-022-07817-6"},{"key":"ref_41","unstructured":"Statistic Division Ministry of Finance the Economy Public Administration Public Broadcasting and Information (2024, March 08). Consumer Price Index. Statistics Division, Ministry of Finance and Corporate Governance, Antigua and Barbuda; 2022, Available online: https:\/\/statistics.gov.ag\/wp-content\/uploads\/2022\/01\/Monthly-CPI-December-2021.pdf."},{"key":"ref_42","unstructured":"OECD, Eurostat, and WHO (2017). A System of Health Accounts 2011, OECD Publishing. [Revised ed.]."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"429","DOI":"10.2307\/3349801","article-title":"Cost-of-Illness Methodology: A Guide to Current Practices and Procedures","volume":"60","year":"1982","journal-title":"Milbank Meml. Fund. Q. Health Soc."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1002\/ijc.23889","article-title":"Breast cancer incidence and mortality in a Caribbean population: Comparisons with African-Americans","volume":"124","author":"Hennis","year":"2009","journal-title":"Int. J. Cancer"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Bovell, A.A.N., Rhudd, A., Ncayiyana, J., and Ginindza, T.G. (2025). Overall Observed Survival of Female Breast, Cervical, Colorectal, and Prostate Cancers in Antigua and Barbuda, 2017\u20132021, Retrospective Data from Four Study Sites. Int. J. Environ. Res. Public Health, 22.","DOI":"10.3390\/ijerph22020235"},{"key":"ref_46","unstructured":"(2024, July 15). IBRD-IDATWB Life Expectancy at Birth, Total (Years)\u2014Antigua and Barbuda n.d. Available online: https:\/\/data.worldbank.org\/indicator\/SP.DYN.LE00.IN?end=2022&locations=AG&skipRedirection=true&start=1960&view=chart."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1016\/j.asjsur.2016.07.005","article-title":"Colorectal cancer in Malaysia: Its burden and implications for a multiethnic country","volume":"40","author":"Veettil","year":"2017","journal-title":"Asian J. Surg."},{"key":"ref_48","unstructured":"The World Bank (2024, April 15). Antigua and Barbuda. World Bank IBRD-IDA. Available online: https:\/\/data.worldbank.org\/country\/AG."},{"key":"ref_49","unstructured":"Browne, G. (2021). Antigua and Barbuda 2021 Budget Statement \u201cMaintaining a Healthy Nation and Restoring a Vibrant Economy\u201d, Government of Antigua and Barbuda. Available online: https:\/\/static1.squarespace.com\/static\/5d8787f48b25fe303ff1434b\/t\/60183184f71f7d6b322f9103\/1612198276978\/Budget_Speech_2021.pdf."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"107327482110099","DOI":"10.1177\/10732748211009952","article-title":"Economic Burden of Colorectal Cancer: A Case of Fars, Iran","volume":"28","author":"Jafari","year":"2021","journal-title":"Cancer Control"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"3111","DOI":"10.3390\/curroncol30030236","article-title":"Predictive Factors for Anastomotic Leakage Following Colorectal Cancer Surgery: Where Are We and Where Are We Going?","volume":"30","author":"Tsalikidis","year":"2023","journal-title":"Curr. Oncol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1007\/s10198-011-0325-z","article-title":"Cost of care for colorectal cancer in Ireland: A health care payer perspective","volume":"13","author":"Tilson","year":"2012","journal-title":"Eur. J. Health Econ."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"887","DOI":"10.4103\/2008-7802.104861","article-title":"The Direct Medical Costs of Colorectal Cancer in Iran; Analyzing the Patient\u2019s Level Data from a Cancer Specific Hospital in Isfahan","volume":"3","author":"Davari","year":"2012","journal-title":"Int. J. Prev. Med."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1093\/jnci\/87.6.417","article-title":"Stage, Age, Comorbidity, and Direct Costs of Colon, Prostate, and Breast Cancer Care","volume":"87","author":"Taplin","year":"1995","journal-title":"JNCI J. Natl. Cancer Inst."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"101174","DOI":"10.1016\/j.tranon.2021.101174","article-title":"Global colorectal cancer burden in 2020 and projections to 2040","volume":"14","author":"Xi","year":"2021","journal-title":"Transl. Oncol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1007\/s10198-019-01130-6","article-title":"Survival and costs of colorectal cancer treatment and effects of changing treatment strategies: A model approach","volume":"21","author":"Joranger","year":"2020","journal-title":"Eur. J. Health Econ."},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Specchia, M.L., Frisicale, E.M., Carini, E., Di Pilla, A., Cappa, D., Barbara, A., Ricciardi, W., and Damiani, G. (2020). The impact of tumor board on cancer care: Evidence from an umbrella review. BMC Health Serv. Res., 20.","DOI":"10.1186\/s12913-020-4930-3"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"e13477","DOI":"10.1111\/ecc.13477","article-title":"Health economic studies of colorectal cancer and the contribution of administrative data: A systematic review","volume":"30","author":"Lemmon","year":"2021","journal-title":"Eur. J. Cancer Care"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1007\/s10198-022-01497-z","article-title":"Lifetime direct healthcare costs of treating colorectal cancer: A systematic review","volume":"24","author":"Bhimani","year":"2023","journal-title":"Eur. J. Health Econ."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/22\/4\/552\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:09:04Z","timestamp":1760029744000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/22\/4\/552"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,3]]},"references-count":59,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["ijerph22040552"],"URL":"https:\/\/doi.org\/10.3390\/ijerph22040552","relation":{},"ISSN":["1660-4601"],"issn-type":[{"type":"electronic","value":"1660-4601"}],"subject":[],"published":{"date-parts":[[2025,4,3]]}}}