Colorectal cancer treatment costs in US double those for Canada
CHICAGO — Colorectal cancer treatment for patients who lived in western Washington State cost more than twice as much as treatment for individuals with the same malignancy who lived in a demographically similar region in Canada, according to study results presented at ASCO Annual Meeting.
“Despite significantly higher costs, patients in western Washington did not [achieve better outcomes] than those who received treatment in British Columbia,” Todd Yezefski, MD, senior fellow at Fred Hutchinson Cancer Research Center and University of Washington School of Medicine, said during a press conference. “Another way to say it is, they got the same bang for more buck.”
Little research has directly compared health care costs, utilization and outcomes between patients who received similar systemic treatments in Canada’s single-payer health system and the United States’ multipayer system.
Yezefski and colleagues used cancer registry and claims data to compare utilization and cost of treatment for metastatic colorectal cancer between geographically close, demographically similar patients in western Washington State and British Columbia. Researchers expressed all costs in 2009 U.S. dollars.
Investigators also assessed survival outcomes between groups.
Researchers used two sources — the BC Cancer Agency Database and a regional database that links western Washington SEER data to claims from two large commercial insurers — to identify 2,197 patients aged 18 years or older diagnosed with metastatic colorectal cancer in 2010 or later.
Nearly three-quarters (73.8%; n = 1,622) lived in British Columbia.
Median age was slightly higher in the British Columbia group (66 years vs. 60 years) because Yezefski and colleagues were not able to access claims data for Medicare recipients in the United States.
Both groups were primarily white, although they had sizable Asian populations.
A higher percentage of patients from British Columbia were men (57% vs. 48%; P < .01). Education and income levels were comparable.
The most common initial systemic treatment for patients in British Columbia was FOLFIRI chemotherapy — which consists of irinotecan, 5-FU and folinic acid — and bevacizumab (Avastin, Genentech). The most common first-line regimen for patients in western Washington was FOLFOX chemotherapy, which consists of oxaliplatin, 5-FU and folinic acid.
A higher percentage of patients in western Washington than British Columbia underwent initial systemic treatment (79% vs. 68%; P < .01). This may be due to the younger age of the U.S. cohort, Yezefski said.
Mean monthly per-patient costs for first-line treatment were significantly higher for those in western Washington ($12,345 vs. $6,195; P < .01). This difference persisted for all regimens assessed.
Mean lifetime monthly costs for systemic therapy also were significantly higher for patients in western Washington ($7,883 vs. $4,830; P < .01).
Despite the higher costs, median OS among those who received systemic treatment did not differ significantly between regions (21.4 months for western Washington vs. 22.1 months for British Columbia).
Among those who did not undergo systemic treatment, median OS was 5.4 months for those in western Washington and 6.3 months for those in British Columbia.
“Drug prices in Canada are generally set by the government,” Yezefski said. “In the United States, we believe that if Medicare is allowed to negotiate drug prices with pharmaceutical companies, drug prices can be lower, and private insurance often will follow suit.”
Yezefski and colleagues acknowledged their current findings are skewed toward younger patients who are not insured through Medicare.
“We plan to continue this work by recruiting Medicare patients in the Washington cohort, which will hopefully increase the age and make the two groups a little more comparable,” he said. “[We also intend to look] at other aspects of health care utilization, such as total duration of chemotherapy, hospital use, radiation receipt and surgery.” – by Mark Leiser
Yezefski T, et al. LBA3579. Presented at: ASCO Annual Meeting; June 1-5, 2018; Chicago.
Disclosure: Fred Hutchinson Cancer Research Center and BC Cancer Agency funded this study. Shankaran reports research funding to her institution from Amgen, Bayer, Bristol-Myers Squibb and Merck. Yezefski reports no relevant financial disclosures. Please see the abstract for all other authors’ relevant financial disclosures.