mCRC Chemo Cost More in US Than in Canada, but Yielded No Better Survival

Despite paying nearly double per month for first-line treatment in the US, patients with mCRC have survival outcomes similar to their Canadian counterparts.

Patients with metastatic colorectal cancer in the United States faced significantly higher costs for systemic therapy compared with similar patients living in British Columbia, Canada. However, this increased cost of treatment did not result in any increase in overall survival.

These data were presented by Todd Yezefski, MD, a senior fellow at the Fred Hutchinson Cancer Research Center and the University of Washington School of Medicine, Seattle, at the 2018 American Society of Clinical Oncology (ASCO) Annual Meeting, held June 1–5 in Chicago.

“Despite significantly higher costs, patients in Western Washington didn’t do any better than those in British Columbia,” Yezefski said, in discussing the study (abstract LBA3579) during a press conference.

Most patients in the United States are covered by private, employer-sponsored plans, with public coverage available for only the elderly or poor. In Canada the system has universal, public coverage. Overall healthcare utilization and cost in the United States are higher than in Canada, but outcomes remain similar, if not worse. Few studies have evaluated healthcare use, cost, and outcomes between US and Canadian patients for a specific disease type.

To compare these groups, the researchers used data from patients in the British Columbia Cancer Agency database (1,622 patients) and a regional database linking Western Washington SEER (Surveillance, Epidemiology, and End Results) claims from two large commercial insurers (575 patients). All patients were 18 years of age or older and had been diagnosed with metastatic colorectal cancer in 2010 or later.

Yezefski noted that the US study data sources did result in an exclusion of older Medicare patients, who are more likely to have a cancer diagnosis. The Canadian patients were more likely to be older (median age 60 vs 66 years) and to be male (57% vs 48%; P = .01).

Significantly more patients in the United States underwent systemic therapy to treat their disease (79% vs 68%; P < .01). In the patients from British Columbia, the most common first-line regimen combined FOLFIRI (leucovorin, 5-FU, irinotecan) plus bevacizumab (32%); in the United States, it was FOLFOX (leucovorin, 5-FU, oxaliplatin; 39%).

In order to account for differences in treatment duration, the researchers looked at cost of treatment per month. The average monthly cost of this first-line therapy was almost double for patients in the United States compared with Canada ($12,345 vs $6,195; P < .01). According to the researchers, this was true for all regimens assessed.

The mean lifetime monthly systemic therapy costs were also significantly higher in patients from Western Washington ($7,883 vs $4,830; P < .01).

Despite these increased costs for patients from the United States, there was no difference in median overall survival between patients receiving systemic therapy (21.4 months vs 22.1 months) and those not receiving systemic therapy (17.4 months vs 16.9 months) in the United States, compared with patients in British Columbia.

Yezefski noted that drug prices in Canada are generally set by the government. “In the United States we believe if Medicare is allowed to negotiate drug prices with pharmaceutical companies drug prices will be lower and private insurers will follow suit with less cost for drugs,” Yezefski said.

Commenting on the study, Richard Schilsky, MD, ASCO’s Chief Medical Officer, said it is interesting to consider that the United States is probably the only country in the world where there is no real way to constrain the cost of healthcare, particularly as it relates to the cost of drugs.

“If you think about it, the US FDA does not consider drug price in any of their deliberations about safety and efficacy, and whether drugs should be allowed to enter the market,” Schilsky said. “Once they are on the market, Medicare is generally required by law to pay for the cost of the drugs, and private insurers generally follow suit. There really is no way to put any brakes on the system, which is not the case in most other healthcare systems in the world.”