“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.” 

About the Study
To focus on differences in health care systems (single payer in Canada vs. both private insurance and government-run programs in the U.S.), 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 than in the United States, but they both provide the same benefit to patients.

The analysis included 1,622 patients with metastatic colorectal cancer in BC and 575 in WW. In the analysis, patients in BC were older than those in WW (median age 66 years vs. 60 years). Dr. Yezefski noted that this difference is due to the researchers not being able to access claims data for Medicare patients in the U.S. The most common initial systemic treatment in BC was FOLFIRI (irinotecan, 5-fluorouracil, and folinic acid) chemotherapy with bevacizumab (Avastin). In WW, most patients received FOLFOX (oxaliplatin, 5-fluorouracil, and folinic acid) chemotherapy. 

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

The mean monthly, per patient cost of initial treatment was significantly higher in WW than in BC ($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 WW and 22.1 months in BC. Among patients who did not receive systemic treatment, the median survival was 5.4 months in WW vs. 6.3 months in BC.

Next Steps
The researchers plan to expand this analysis to include claims data from older patients in WW. 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 Dr. Veena Shankaran, 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.

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

Study at a Glance

View the full abstract.

For your readers:

• Guide to Colorectal Cancer (Cáncer colorectal)
• Understanding Chemotherapy (Qué es la quimioterapia)
• Understanding the Costs Related to Cancer Care
  (Comprensión de los costos relacionados con la atención del cáncer)

ATTRIBUTION TO THE AMERICAN SOCIETY OF CLINICAL ONCOLOGY ANNUAL MEETING IS REQUESTED IN ALL COVERAGE.

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