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. 2021 Mar;123(4):1023-1029.
doi: 10.1002/jso.26390. Epub 2021 Jan 26.

Cost drivers of locally advanced rectal cancer treatment-An analysis of a leading healthcare insurer

Fabian Grass  1   2 , Amit Merchea  3 , Kellie L Mathis  1 , Nitin Mishra  4 , Herbert Heien  5 , Lindsey R Sangaralingham  5 , David W Larson  1
Affiliations

Cost drivers of locally advanced rectal cancer treatment-An analysis of a leading healthcare insurer

Fabian Grass et al. J Surg Oncol. 2021 Mar.

Abstract

Background: To evaluate the economic burden of locally advanced rectal cancer (LARC) treatment from a society perspective through analysis of health insurance-derived data of commercially insured and Medicare Advantage (MA) patients.

Methods: Retrospective cost analysis of patients undergoing rectal resection within a multimodal (neoadjuvant chemoradiation + adjuvant chemotherapy) treatment strategy between January 1, 2010 and October 31, 2018, using the claims OptumLabs Data Warehouse database.

Results: In total, 1738 (935 commercial and 803 MA) patients were included. Overall treatment costs totaled $230,881,746 (on average $183 653 ± 82 384 per commercially insured and $73 681 ± 32 917 per MA patient). Cost distribution according to category (commercially insured patients) was: 29.92% related to outpatient care (follow-up visits/diagnostics), radiotherapy: 21.83%, index resection: 20.62%, chemotherapy: 17.44%, surgical inpatient: 6.32%, medical inpatient: 3.28%, emergency room: 0.58%. Relative cost distribution of the index resection itself differed marginally between the three approaches and was 21.49% for open, 19.30% for laparoscopic, and 20.93% for robotic surgery. Relative cost distributions of neoadjuvant, adjuvant, and outpatient treatments remained unchanged, independently of the surgical approach. This representation was similar in MA patients.

Conclusion: Index-surgery related costs were outweighed by costs related to oncological and outpatient workup/follow-up treatments independently of both surgical approach and insurance type.

Keywords: cost; multidisciplinary; rectal cancer treatment.

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References

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