REAL WORLD HEALTHCARE RESOURCE UTILIZATION AND COSTS IN METASTATIC COLORECTAL CANCER (MCRC) PATIENTS BY LINE OF THERAPY IN THE UNITED STATES
Author(s)
Nedra Joseph, PhD1, Qian Shi, PhD1, Shanthy krishnarajah, PhD1, Denise D’Andrea, MD2, Paul Cifuentes, MD2, Hsien-Yen Chang, PhD1, Cheryl Q. Xiang, MBA3, Yan Wang, ScD4, Zev Wainberg, MD5.
1Johnson & Johnson, Titusville, NJ, USA, 2Johnson & Johnson, Horsham, PA, USA, 3Analysis Group, Boston, MA, USA, 4Analysis Group, Los Angeles, CA, USA, 5University of California, Los Angeles, CA, USA.
1Johnson & Johnson, Titusville, NJ, USA, 2Johnson & Johnson, Horsham, PA, USA, 3Analysis Group, Boston, MA, USA, 4Analysis Group, Los Angeles, CA, USA, 5University of California, Los Angeles, CA, USA.
OBJECTIVES: Colorectal cancer (CRC) is the 4th most common cancer and 2nd cause of cancer mortality in the US. 33-45% of CRC patients develop metastatic disease, with only 15% achieving 5-year overall survival. This retrospective real-world study assessed healthcare resource utilization (HCRU) and cost among 1st-line (1L), left-sided 1L, and 2nd-line (2L) mCRC patients.
METHODS: Optum Clinformatics® insurance claims data (Jan 2018-Mar 2024) were analyzed descriptively. 1L patients had ≥2 CRC and ≥1 metastasis diagnosis, with continuous enrollment from ≥12 months pre-index to ≥3 months post-1L or 2L initiation (unless death occurred). Patients without mCRC treatment ≤28 days prior or any time on/after index metastasis were excluded from 1L cohort. Tumor sidedness was based on 2 CRC diagnoses closest to index metastasis. 2L cohort were 1L patients initiating 2L therapy. Patients were identified only using ICD-CM codes due to unavailability of clinical details (e.g. tumor stage, mutation status).
RESULTS: Analytic sample included 12,419 1L mCRC patients (52.5% left-sided); 4,040 progressed to 2L. Median age was 71.0 years, 54.0% male, and 70.6% Medicare Advantage. All-cause costs were $17,840 per patient per month (PPPM) in overall 1L and $19,036 in left-sided 1L. CRC-related costs were $15,214 PPPM in 1L (26.6% [$4,020] on CRC treatment, 73.4% [$11,484] on medical services) and $16,463 in left-sided 1L (24.1% [$3,968] on CRC treatment, 75.9% [$12,495] on CRC-related medical service). In 2L, all-cause costs were $19,371 PPPM, CRC-related $17,301, including 33.6% ($5,817) spent on CRC treatment. Patients had 6.5 outpatient visits PPPM in 1L and 6.4 in 2L (4.9 and 5.0 CRC-related, respectively); 7.1 visits in 1L left-sided patients (5.4 CRC-related).
CONCLUSIONS: mCRC patients face a significant economic and utilization burden, with monthly costs exceeding $17k-$19k and >85% CRC-related, primarily driven by medical services. Intensive outpatient care highlights opportunities to optimize delivery and advance value-based oncology strategies.
METHODS: Optum Clinformatics® insurance claims data (Jan 2018-Mar 2024) were analyzed descriptively. 1L patients had ≥2 CRC and ≥1 metastasis diagnosis, with continuous enrollment from ≥12 months pre-index to ≥3 months post-1L or 2L initiation (unless death occurred). Patients without mCRC treatment ≤28 days prior or any time on/after index metastasis were excluded from 1L cohort. Tumor sidedness was based on 2 CRC diagnoses closest to index metastasis. 2L cohort were 1L patients initiating 2L therapy. Patients were identified only using ICD-CM codes due to unavailability of clinical details (e.g. tumor stage, mutation status).
RESULTS: Analytic sample included 12,419 1L mCRC patients (52.5% left-sided); 4,040 progressed to 2L. Median age was 71.0 years, 54.0% male, and 70.6% Medicare Advantage. All-cause costs were $17,840 per patient per month (PPPM) in overall 1L and $19,036 in left-sided 1L. CRC-related costs were $15,214 PPPM in 1L (26.6% [$4,020] on CRC treatment, 73.4% [$11,484] on medical services) and $16,463 in left-sided 1L (24.1% [$3,968] on CRC treatment, 75.9% [$12,495] on CRC-related medical service). In 2L, all-cause costs were $19,371 PPPM, CRC-related $17,301, including 33.6% ($5,817) spent on CRC treatment. Patients had 6.5 outpatient visits PPPM in 1L and 6.4 in 2L (4.9 and 5.0 CRC-related, respectively); 7.1 visits in 1L left-sided patients (5.4 CRC-related).
CONCLUSIONS: mCRC patients face a significant economic and utilization burden, with monthly costs exceeding $17k-$19k and >85% CRC-related, primarily driven by medical services. Intensive outpatient care highlights opportunities to optimize delivery and advance value-based oncology strategies.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
PT5
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
SDC: Gastrointestinal Disorders, SDC: Oncology