Original article—alimentary tract
Lifetime and Treatment-Phase Costs Associated With Colorectal Cancer: Evidence from SEER-Medicare Data

Portions of this study were presented in preliminary form at the 13th Annual Meeting of the International Society for Pharmacoeconomics and Outcomes Research, May 5, 2008, Toronto, Ontario, Canada; and the 44th Annual Meeting of the American Society of Clinical Oncology, June 3, 2008, Chicago, IL.
https://doi.org/10.1016/j.cgh.2008.08.034Get rights and content

Background & Aims

This study provides detailed estimates of lifetime and phase-specific colorectal cancer (CRC) treatment costs.

Methods

This retrospective cohort study included patients aged 66 years and older, newly diagnosed with CRC in a Surveillance Epidemiology and End Results (SEER) registry (1996–2002), matched 1:1 (by age, sex, and geographic region) to patients without cancer from a 5% sample of Medicare beneficiaries. The Kaplan–Meier sample average estimator was used to estimate observed 10-year costs, which then were extrapolated to 25 years. A secondary analysis computed costs on a per-survival-year basis to adjust for differences in mortality by stage and age. Costs were expressed in 2006 US$, with future costs discounted 3% per year.

Results

Our sample included 56,838 CRC patients (41,256 colon cancer [CC] patients and 15,582 rectal cancer [RC] patients; mean ± SD age, 77.7 ± 7.1 y; 55% women; and 86% white). Lifetime excess costs were $29,500 for CC and $26,500 for RC patients. Per survival year, stage IV CRC patients incurred $31,000 in excess costs compared with $3000 for stage 0 patients. CRC patients incurred excess costs of $33,500 in the initial phase, $4500/y in the continuing phase, and $14,500 in the terminal phase. RC patients had lower costs than CC patients in the initial phase, but higher costs in both the continuing and terminal phases.

Conclusions

Excess costs associated with CRC are striking and vary considerably by treatment phase, cancer subsite, and stage at diagnosis. Interventions aimed at earlier diagnosis and prevention have the potential to reduce cancer-related health care costs.

Section snippets

Data Sources

This study used 3 data sources: (1) the linked Surveillance Epidemiology and End Results (SEER)–Medicare database (a collaborative effort of the National Cancer Institute, the SEER registries, and the Centers for Medicare and Medicaid Services); (2) the SEER*Stat database, containing clinical and survival data from the SEER registries; and (3) survival data for the general population from US life-tables.

SEER is a US cancer surveillance system consisting of population-based tumor registries

Patient Characteristics

We identified 56,838 CRC patients (41,256 colon cancer [CC], 15,582 rectal cancer [RC]) who met our selection criteria. Demographic and clinical characteristics for CC patients, RC patients, the combined CRC cohort, and the comparison cohort are presented in Table 1. The mean ± SD age was 77.7 ± 7.1 years; about 55% of patients in both cohorts were women and 86% were white.

Lifetime Cost Estimates

Total lifetime cancer-related costs were $28,500, with an inverted U-shaped pattern by stage and a U-shaped pattern by age (

Discussion

This study evaluated lifetime and phase-specific excess costs among elderly patients with CRC in the United States. We found that lifetime CRC-related costs are substantial and vary by cancer subsite, stage at diagnosis, age at diagnosis, and treatment phase. Excess lifetime costs show an inverted U-shaped pattern by stage at diagnosis, and a U-shaped pattern by age at diagnosis for both CC and RC. Costs for RC patients are lower than costs for CC patients in stage 0, higher in stages I to III,

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    The authors disclose the following: This study was sponsored by a grant from GE Healthcare, Waukesha, WI. D.W.L. is an employee of GE Healthcare; K.L., L.M.L., J.R.K., and J.M. received research funding from GE Healthcare; and C.C.E. is a consultant for Boston Health Economics.

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