Drugs for treating colon cancer cost less north of border: study
But health outcomes for patients studied in B.C. and Washington state are similar
Monthly chemotherapy drugs for metastatic colorectal cancer treatment cost twice as much in Seattle as in Vancouver, a research collaboration between Fred Hutchinson Cancer Research Centre and B.C. Cancer shows.
Spending double on the same chemotherapy drugs for patients with advanced disease yields no survival benefit, say experts conducting the comparative research. Survival in each jurisdiction was about the same: 22 months.
The ongoing cross-border collaboration was presented in abstract form to oncologists attending the 2018 American Society of Clinical Oncology meeting in Chicago. A manuscript of the study results is being prepared for submission to a medical journal.
At last month’s meeting, a poster presentation showed monthly costs for chemotherapy drugs per patient were about $12,345 in Washington state compared with $6,195 in B.C. (Costs were converted to U.S. dollars and based on values in 2009, since the participants in the study were patients diagnosed between 2010 and 2017).
The study was based on an analysis of 1,622 patients in B.C. and 575 in Western Washington state; all patients had late-stage, often incurable colorectal cancer.
Demographics between patients were similar except the median age of B.C. patients was a bit older: 66 compared to 60 in Washington.
B.C. patients were also more likely to be male (57 per cent versus 48 per cent in Washington).
While similar drugs were used, 79 per cent of patients in the U.S. were offered chemotherapy compared to 68 per cent in B.C. Survival among patients who didn’t receive chemotherapy was 6.1 months in B.C. and 5.4 months in Washington.
While the median survival with chemotherapy was 21.4 months in Washington and 22.1 in B.C., the overall survival for all patients — both those who had and did not have chemotherapy — was 17.4 months in Washington and 16.9 months in B.C.
Dr. Todd Yezefski, lead author of the Washington group and a senior fellow at the University of Washington School of Medicine and Fred Hutchinson Cancer Research Center, said in an interview that drug costs are cheaper in Canada because the federal government negotiates prices with pharmaceutical companies, while in the U.S. there is no such process “because Congress doesn’t allow such negotiations.”
He agreed that U.S. health insurers are probably looking at the results of the study and shaking their heads over the much higher costs, but their hands are tied.
In Canada, the federal government looks at what numerous other countries are paying for drugs and generally negotiates a median price, he said.
Study co-investigator Dr. Hagen Kennecke, an oncologist at B.C. Cancer when the study began who is now in a leadership position at Virginia Mason in Seattle, said when the Washington group approached B.C. experts about the collaboration, “I have to confess we (Canadians) were a bit nervous going into this.
“But the data is reassuring in the sense that outcomes for patients are the same. It’s just the costs of drugs that aren’t and the overspending on drugs does not appear to yield any (survival) benefits to patients.”
Dr. Dan Le, an oncology fellow and lead investigator on the study for B.C. Cancer, said the next phase of the project is looking at the use of radiation and surgery in the same cohort of patients, comparing not the costs but the utilization of such interventions. That data will be used to determine if the differences in the volumes of surgery and radiation affect patient outcomes (survival).
Hypothetically, if, for example, more patients in Washington undergo surgery and/or radiation but survival outcomes are the same, then it begs the question: are those appropriate, justifiable interventions to use on patients with advanced colorectal cancer?
Surgery and radiation are sometimes offered to patients with advanced cancer for palliative reasons, to relieve symptoms and pain.
Le said while there was an obvious difference in costs of chemo drugs between B.C. and Washington, “one should be careful not to extrapolate too much,” referring to the fact that this was one fairly homogeneous group of patients with one type of cancer.
“The main conclusion is that in B.C., we can achieve similar outcomes, at very different — much lower — costs.”
Kennecke said colorectal cancer is a good type to study because it is one of the most common and is the second leading cause of cancer deaths.
A recent Canadian Cancer Society report drew attention to the fact that colorectal cancer has already spread in half of all cases by the time it is diagnosed. That, despite the fact that most provinces, including B.C., have screening programs meant to diagnose such cancers earlier, to improve the prognosis for 3,600 individuals who will get colorectal cancer in this province in 2018.