Direct Healthcare Cost of Cachexia in Patients With Breast, Colorectal, Lung, Pancreatic, and Prostate Cancers: A Retrospective Observational Study

OBJECTIVES: To compare direct healthcare costs in patients with malignant solid tumors with and without cachexia.

METHODS: This retrospective observational study analyzed the Optum Market Clarity database. Patients with an incident breast, colorectal, lung, pancreatic, or prostate cancer diagnosis in select settings between October 1, 2016 and September 30, 2022, who had ≥2 bodyweight measurements within 150-210 days and ≥1 measurement after the cancer index date were included. Cachexia cases had ≥5% bodyweight loss between measurements (Fearon criteria); the second measurement was designated the cachexia index date. Patients with <5% bodyweight loss served as controls, with index dates imputed as the second of 2 weight measurements 150-210 days apart. Inverse probability of treatment weights helped balance baseline variables across groups at the cachexia index date. The primary outcome was mean total healthcare costs per patient per month (PPPM) during the 12 months after cachexia index date, categorized as hospital inpatient, hospital outpatient, office, home/telehealth, and other costs. T-tests were used to compare costs in cases vs controls by tumor type.

RESULTS: The study included 27,428 patients with breast (3,595 cases/6,905 controls), colorectal (1,683/1,621), lung (1,845/1,500), pancreatic (350/125), or prostate (2,865/6,939) cancer. Mean total costs PPPM were significantly higher in cachexia cases vs controls in breast ($5,269 vs $3,721; p<0.0001), colorectal ($6,186 vs $4,648; p<0.0001), lung ($11,422 vs $9,298; p=0.0002), and prostate ($4,126 vs $2,942; p<0.0001) cancers but not pancreatic cancer ($13,864 vs $12,161; p=0.3561). The largest differences between cases and controls were in hospital outpatient costs in breast and pancreatic cancers, and hospital inpatient costs in colorectal, lung, and prostate cancers.

CONCLUSIONS: Cachexia is associated with significant increases in PPPM healthcare costs among patients with incident breast, colorectal, lung, and prostate cancers, and a non-significant increase in costs in pancreatic cancer. Differences were driven by hospital outpatient and inpatient costs.