2018 ASCO: Treatment for Colorectal Cancer in Washington State Costs Twice as Much as in Neighboring Area of Canada, Despite No Difference in Survival

Key Points

  • The mean monthly, per patient cost of initial treatment was significantly higher in Western Washington State than in British Columbia ($12,345 vs $6,195).
  • There were no differences in median overall survival between the two regions among those receiving systemic treatment and those not receiving treatment.
  • Among those receiving systemic treatment, the median overall survival was 21.4 months in Western Washington State and 22.1 months in British Columbia. Among patients who did not receive systemic treatment, the median survival was 5.4 months in Western Washington State vs 6.3 months in British Columbia.

An analysis of health claims data from two demographically similar regions on either side of the U.S./Canada border shows that a common treatment for advanced colorectal cancer costs twice as much in Western Washington State than in British Columbia—$12,345 vs $6,195 monthly per patient. Despite the higher cost, the patients on the U.S. side of the border are not living longer than those on the Canadian side. The study was featured in a press briefing today and presented by Yezefski et al at the 2018 ASCO Annual Meeting (Abstract LBA3579).

“To our knowledge, this is the first study to directly compare treatment cost and use, along with health outcomes, in two similar populations treated in different health care models,” said lead study author Todd Yezefski, MD, a senior fellow at the Fred Hutchinson Cancer Research Center in Seattle and the University of Washington School of Medicine. “Understanding these differences may help us improve care and potentially lower health-care costs.”

Study Methods

To focus on differences in health-care systems (single-payer in Canada vs both private insurance and government-run programs in the United States), researchers selected two regions that are demographically similar. In addition to being geographically close, British Columbia and Western Washington State both have a mostly white population with a large Asian minority. They are also similar in income level and education.

Initial systemic treatments for advanced colorectal cancer are also similar in the two countries, although the specific treatment regimen typically used is different in Canada from that in the United States, but they both provide the same benefit to patients.

The analysis included 1,622 patients with metastatic colorectal cancer in British Columbia and 575 in Western Washington State. In the analysis, patients in British Columbia were older than those in Western Washington State (median age = 66 vs 60 years). Dr. Yezefski noted this difference is due to the researchers not being able to access claims data for Medicare patients in the United States. The most common initial systemic treatment in British Columbia was FOLFIRI (irinotecan, fluorouracil [5-FU], and leucovorin) chemotherapy with bevacizumab (Avastin). In Western Washington State, most patients received FOLFOX (oxaliplatin, 5-FU, and leucovorin) chemotherapy.

Key Findings

Researchers found differences in both treatment use and costs, but not in survival. Overall, more patients in Western Washington State than in British Columbia received initial systemic treatment (79% vs 68%). Dr. Yezefski noted that this may be because the patients in Western Washington State were younger, on average.

The mean monthly, per-patient cost of initial treatment was significantly higher in Western Washington State than in British Columbia ($12,345 vs $6,195).

There were no differences in median overall survival between the two regions among those receiving systemic treatment and those not receiving treatment. Among those receiving systemic treatment, the median overall survival was 21.4 months in Western Washington State and 22.1 months in British Columbia. Among patients who did not receive systemic treatment, the median survival was 5.4 months in Western Washington State vs 6.3 months in British Columbia.

Next Steps

The researchers plan to expand this analysis to include claims data from older patients in Western Washington State. The authors noted that the current analysis is skewed towards younger patients who are not insured through Medicare. They also hope to compare utilization and costs of other common treatments for colorectal cancer, such as radiation therapy and surgery.

“This study is a first step in an effort to understand the complexities influencing cancer care costs and outcomes in these two regions. Our goal at HICOR is to collect and share data that will bring about improved care while addressing the rising costs of cancer,” said Veena Shankaran, MD, the study’s principal investigator and an associate member at Fred Hutch.

More research is also needed to determine if there are any differences in quality of life and symptom burden between different populations. This is beyond the scope of this study, however, as such information is not included in health claims data.

Commentary

“This study adds important context to the ongoing national conversation about rising treatment costs. As oncologists, we see the burden of high costs on patients and their families every day. In fact, as ASCO’s National Cancer Opinion Survey shows, many patients even forget, delay, or skimp on treatments due to costs, potentially compromising their effectiveness,” said ASCO Chief Medical Officer Richard Schilsky, MD, FACP, FASCO.

This study received funding from the Fred Hutchinson Cancer Research Center and BC Cancer Agency.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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