Colorectal Cancer Treatment Twice as Costly in US as in Canada

Roxanne Nelson, BSN, RN

June 01, 2018

CHICAGO — The cost of treating advanced colorectal cancer is twice as expensive in the United States as it is in Canada, even though outcomes are similar. A new study found that the overall survival was nearly identical.

Presented here at the American Society of Clinical Oncology (ASCO) 2018, the study found that in Western Washington State, the mean monthly cost of first-line therapy per patient was $12,345, compared with $6195 for patients living just north of the border in British Columbia, Canada.

 "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.

"Despite significantly higher cost for systemic therapy in Western Washington compared to British Columbia, overall survival was similar."  

"So despite the higher cost, they got the same bang for more buck," he said.

So despite the higher cost, they got the same bang for more buck. Dr Todd Yezefski

 The high cost of healthcare in the United States and, in particular, the high cost of drugs has been a hotly debated issue in recent years. A recent study found that the United States spends nearly double of what 10 other wealthy nations spend on healthcare. Drug costs are a particularly hot issue, as US patients have the dubious honor of paying the highest costs for drugs in the world.

Higher Cost, Same Outcomes

What makes this study unique is that Yezefski and his colleagues looked at the differences in healthcare systems in two very similar neighboring high-income countries that have very different healthcare delivery systems: single-payer in Canada and both private insurance and government-run programs in the United States.

In addition, they selected two regions that border right on one another and that are not only geographically close but demographically similar. British Columbia and Western Washington State both comprise a predominantly white population with a large Asian minority and are also very similar in income and education levels.

The cohort included 1622 patients diagnosed with metastatic colorectal cancer (mCRC) in British Columbia and 575 in Western Washington. All patients were diagnosed in 2010 and identified from the BC Cancer Agency database and a regional database linking Western Washington Surveillance, Epidemiology, and End Results database to claims from two large commercial insurers. Canadian costs were expressed in US dollars using the Purchasing Power Parity for Health in 2009.

The authors found that patients in Canada were older than those in the US cohort (median age, 66 years vs 60 years). Yezefski noted that this difference was primarily due to the inability to access claims data for Medicare patients in the United States.

A greater proportion of US patients received systemic therapy compared with the Canadian cohort (79% vs 68%; P < .01), and there were differences in the chemotherapy regimen.  The most common first-line systemic treatment in British Columbia, at 32%, was FOLFIRI (irinotecan, 5-fluorouracil, and folinic acid) with added bevacizumab (Avastin, Genentech), while in Western Washington, at 39%, it was FOLFOX (oxaliplatin, 5-fluorouracil, and folinic acid) chemotherapy.

The mean monthly cost of first-line therapy per patient was significantly higher in Western Washington than in British Columbia for all regimens assessed. The mean lifetime monthly costs for systemic therapy were also significantly higher in the US cohort ($7883 vs $4830; P ≤ .01).

But despite the higher cost, median overall survival did not differ between populations in this analysis (21.4 months [95% confidence interval (CI), 18.0 - 26.2 months] in the United States and 22.1 months [95% CI, 20.5 - 23.7 months] in Canada) among those receiving systemic therapy, as well as for patients who did not receive chemotherapy (5.4 months [95% CI, 2.4 - 7.7 months] vs 6.3 months [95% CI, 5.2 - 7.3 months], respectively).

"As drug prices are set by the government in Canada, we believe that if Medicare is allowed to negotiate drug prices, many private insurers may follow suit as Medicare reimbursement rates often guide the private sector," he said.

Yezefski added that the team now plans to expand the analysis to include claims data from older patients in the United States, as the current data are skewed toward younger patients who are not Medicare recipients. They also would like to compare the utilization and costs of common treatments used by this population, including radiation therapy and surgery. 

Put the Brakes On

Commenting on the study, Richard Schilsky, MD, chief medical officer of ASCO, pointed out that while the treatment regimens were very similar, the regimen used in Canada was probably a little more expensive because it included bevacizumab.

There is no way of putting brakes on the system. Dr Richard Schilsky


"The bottom line is that both populations had essentially identical overall survival, at  around 21 to 22 months, but cost of treatment was literally half in Canada," he told Medscape Medical News. "I'm not sure what conclusions one can draw from this except to say that it is possible to deliver good outcomes at a lower cost in health systems that are different from the US, and this is a further example."

He noted that the United States is "probably the only country where we have no way of constraining healthcare costs," and this is especially true for drug costs.

"There is no way of putting brakes on the system, and that is not the case in other healthcare systems in other countries," Schilsky emphasized.

This study received funding from the Fred Hutchinson Cancer Research Center and BC Cancer Agency. Yezefski has disclosed no relevant financial relationships. Several coauthors have disclosed relationships with industry.

American Society of Clinical Oncology (ASCO) 2018 Annual Meeting. To be presented June 3, 2018. Abstract LBA3579

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