Cost of illness in patients with metastatic colorectal cancer

Figures & data

Table 1.  Patient demographic and baseline clinical characteristics.

Characteristic	mCRC cases		Controls		p-value
	N = 6,675	%	N = 6,675	%
Mean age, (years, SD)	64.1	13.1	62.6	14.1	<0.001
Male	3,704	55.5%	3,704	55.5%	1.000
Geographic region
North Central	1,958	29.3%	1,958	29.3%	1.000
Northeast	657	9.8%	657	9.8%	1.000
South	2,711	40.6%	2,711	40.6%	1.000
West	1,349	20.2%	1,349	20.2%	1.000
Urban	5,439	81.5%	5,456	81.7%	0.704
Insurance plan type
Comprehensive	1,837	27.5%	2,028	30.4%	<0.001
PPO	2,893	43.3%	2,560	38.4%	<0.001
HMO	1,215	18.2%	1,231	18.4%	0.720
Other	730	10.9%	856	12.8%	<0.001
Medicare beneficiary	2,856	42.8%	2,747	41.2%	0.056
Mean length of follow-up (days, SD)	492	426	800	531	<0.001
Charlson Comorbidity Index (cancer is removed from CCI)
0	4,892	73.3%	4,892	73.3%	1.000
1	1,278	19.1%	1,278	19.1%	1.000
2	297	4.4%	297	4.4%	1.000
3	138	2.1%	138	2.1%	1.000
4+	70	1.0%	70	1.0%	1.000
Mean CCI (SD)	0.39	0.80	0.39	0.82	0.898
Colon vs. rectal cancer (first occurring diagnosis is colon)	4,651	69.7%
Site of metastasis
196 Secondary and unspecified malignant  neoplasm of lymph nodes	179	2.7%
197 Secondary malignant neoplasm of respiratory  and digestive systems
197.0 Lung	1,009	15.1%
197.7 Liver, specified as secondary	3,124	46.8%
197.6 Retroperitoneum and peritoneum	772	11.6%
Other	343	5.1%
198 Secondary malignant neoplasm of other specified sites	1,248	18.7%

Table 2.  Monthly healthcare resource utilization: mCRC cases and controls.

Resource utilization	mCRC Cases			Controls			p-value on % of patient use
	Patients with any use during the whole follow-up %	Number of services across all patients per month		Patients with any use during the whole follow-up %	Number of services across all patients per month
		Mean	SD		Mean	SD
Hospital inpatient admissions	86.9	0.37	1.23	17.3	0.05	0.00	<0.001
Bowl or metastasectomy resection	38.4	0.08	0.54	0.1	0.00	0.00	<0.001
Emergency room visits	55.5	0.18	0.66	27.4	0.03	0.08	<0.001
Outpatient office visits	86.4	1.42	1.42	79.4	0.34	0.50	<0.001
Primary care	65.4	0.47	0.84	66.8	0.19	0.35	0.079
Oncologist	32.6	0.35	0.88	0.3	0.00	0.01	<0.001
Hematologist	23.8	0.22	0.59	0.4	0.00	0.02	<0.001
Radiologist	7.5	0.02	0.12	0.4	0.00	0.01	<0.001
Surgeon	40.1	0.08	0.20	18.8	0.02	0.07	<0.001
Other specialist	48.0	0.19	0.46	48.0	0.10	0.23	0.986
Facility provider	6.6	0.03	0.18	6.6	0.01	0.08	0.944
Other/unknown	15.2	0.07	0.42	11.7	0.02	0.13	<0.001
Outpatient hospital visits	35.2	0.23	1.61	6.5	0.01	0.06	<0.001
Primary care	11.1	0.04	0.22	2.6	0.00	0.03	<0.001
Oncologist	7.4	0.03	0.24	0.0	0.00	na	<0.001
Hematologist	2.7	0.01	0.11	0.0	0.00	na	<0.001
Radiologist	6.7	0.01	0.07	0.1	0.00	0.00	<0.001
Surgeon	6.7	0.01	0.11	0.8	0.00	0.01	<0.001
Other specialist	8.9	0.02	0.15	2.7	0.00	0.03	<0.001
Facility provider	14.0	0.09	1.50	2.4	0.00	0.04	<0.001
Other/unknown	6.3	0.01	0.20	0.8	0.00	0.02	<0.001
Outpatient pharmacy claims	79.9	2.55	2.63	83.5	1.73	2.05	<0.001

Table 3.  Monthly healthcare costs: mCRC cases and controls.

	mCRC Patients (N = 6675)		Control Patients (N = 6675)		Difference	P value
	Mean	SD	Mean	SD
All Cause Costs	$15,179	$49,095	$593	$1,719	$14,585	<0.001
Hospital Inpatient Admissions	$7,745	$45,735	$199	$1,315	$7,546	<0.001
Surgical Resections	$2,365	$14,971	$1	$55	$2,364	<0.001
Emergency Room Visits	$106	$728	$12	$91	$95	<0.001
Total Outpatient Services	$6,980	$9,259	$230	$750	$6,749	<0.001
Outpatient chemotherapy	$1,273	$2,027	$0	$1	$1,273	<0.001
Outpatient biologics	$1,280	$2,491	$0	$0	$1,280	<0.001
Outpatient Office Visits	$129	$184	$29	$83	$101	<0.001
Outpatient Hospital Visits	$27	$183	$1	$7	$26	<0.001
Other Outpatient	$4,271	$7,568	$201	$735	$4,070	<0.001
Outpatient Pharmacy Claims	$348	$731	$152	$240	$195	<0.001
mCRC-Related Costs	$9,798	$44,649
Hospital Inpatient Admissions	$5,111	$42,764
Surgical Resections	$2,177	$14,636
Emergency Room Visits	$18	$347
Total Outpatient Services	$4,669	$6,158
Outpatient chemotherapy	$1,036	$1,791
Outpatient biologics	$1,091	$2,218
Outpatient Office Visits	$90	$171
Outpatient Hospital Visits	$19	$173
Other Outpatient	$2,433	$3,957

Figure 1.  Kaplan–Meier survival estimates, by mCRC status.

Table 4.  Incremental costs estimated using survival-based method.

Year	mCRC patients		Controls		Incremental costs ($)
	Cost ($)	95% CI	Cost ($)	95% CI
0–1	103,806	[101,091–106,184]	5,955	[5,546–6,351]	97,851
0–2	145,334	[141,276–148,996]	10,857	[10,196–11,506]	134,478
0–3	169,861	[164,428–174,520]	15,622	[14,782–16,511]	154,239
0–4	183,840	[177,905–189,318]	20,440	[19,282–21,615]	163,400

Figure 2.  Percentage of total costs that are due to chemotherapy and biologics.