Cost of Treating Colorectal Cancer in the United States Double That of Canada, with No Survival Benefitc

August 2018, Vol 9, No 2 | Payers’ Perspectives In Oncology: ASCO

Chicago, IL—Healthcare costs in the United States have spiraled out of control, and polls show that single-payer healthcare is gaining traction. Our Canadian neighbors have had a single-payer system for a long time. A study presented at ASCO 2018 puts exact numbers on what it costs to receive treatment for metastatic colorectal cancer (CRC) in demographically similar populations in Washington State versus British Columbia, geographic areas separated by a line of sand but vastly different in terms of "bang for the buck" in cancer care.

The monthly costs for first-line chemotherapy per patient in Washington State averaged $12,345 in the United States versus $6195 in Canada, and survival was similar, at approximately 22 months.

"To our knowledge, this is the first study to directly compare treatment cost and use along with health outcomes in 2 similar populations treated in different healthcare models. Understanding these differences may help us improve care and potentially lower healthcare costs," said lead investigator Todd Yezefski, MD, MS, Senior Fellow, Fred Hutchinson Cancer Research Center, Seattle, WA, who presented the results. "The differences in costs are dramatic, and outcomes are similar in the United States, if not worse."

The investigators analyzed the health claims of 1622 Canadian patients and 575 US patients separately. Investigators at the Fred Hutchinson Cancer Research Center and the British Columbia Cancer Agency worked separately and then shared their findings. The patients enrolled in the study were diagnosed with CRC in 2010 in both geographic areas. The costs were converted into US dollars according to 2009 value.

The US data were provided by private insurers (ie, Premera Blue Cross and Regence BlueShield). There was no access to US Medicare data, except for Medicare patients who had Medicare supplement policies with these insurers. The Canadian data were based on British Columbia Cancer Agency data from Vancouver province covered by the single-payer system.

Both patient populations had similar demographics, with 2 exceptions—the median age of patients was 6 years older in British Columbia (ie, 60 years in the United States and 66 years in British Columbia) and there were more males in British Columbia (48% vs 57%, respectively).

More patients in the United States received chemotherapy than in British Columbia (79% vs 68%, respectively). Among patients who did not receive chemotherapy, survival was substantially shorter, with a median overall survival (OS) of 5.4 months in Washington State and 6.1 months in British Columbia.

The first-line cost of chemotherapy was $12,345 monthly per patient in the United States and $6195 monthly in British Columbia (P <.01). The mean monthly cost of the most common first-line chemotherapy (FOLFOX in the United States and FOLFIRI plus bevacizumab in Canada) was $11,814 and $8992, respectively (P = .07). The mean lifetime cost of chemotherapy per month in the US cohort was $7883 versus $4830 in the Canadian cohort (P <.01).

The median OS with systemic therapy was similar—21.4 months in the United States and 22.1 months in British Columbia. The median OS for all patients enrolled in the study (treated and untreated) was 17.4 months and 16.9 months, respectively.

"Patients in Washington state did not do any better than in British Columbia. They got the same bang for more buck. The drug prices in Canada are set by the government. We believe if Medicare was allowed to negotiate with drug makers, costs in the US could be lowered," Dr Yezefski said.

The study investigators plan to expand the analysis to include data from older adults in Washington and British Columbia. They hope to compare the utilization and costs of other treatments for CRC, including radiation and surgery, and to assess quality of life and symptom burden between different populations, which is not included in health claims data.

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