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.

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 studyfound 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.