Getting treatment for colorectal cancer can cost twice as much in the United States as in Canada, with no apparent improvement in survival chances, according to a comparative study released at a 2014 ASCO Cancer Congress.
The study compared patients with advanced colorectal cancer in two regions with similar populations but only separated by a border: western Washington State, in the northwestern United States, and British Columbia, in Canada.
The cost of treating Canadian patients averaged US $ 6,195 per month, compared to US $ 12,345 on the US side. This cost does not generally correspond to what patients had to pay, the insurance taking care of the treatments.
Both groups of patients were treated with chemotherapy, but more American patients opted for the strongest treatment. In detail, the most common initial treatment in British Columbia was FOLFIRI (irinotecan, 5-fluorouracil and folinic acid) chemotherapy combined with bevacizumab (Avastin). In Washington, most patients received FOLFOX (oxaliplatin, 5-fluorouracil and folinic acid) chemotherapy.
…for the same result
The Americans and the Canadians lived about the same length of time: 21.4 months for the former, from the diagnosis, and 22.1 months for the latter.
The study is interesting because Canada has a single, publicly funded health care system, while the US system is mostly private, with individual and employer-sponsored insurance. Americans spend a lot more on their health than people in other developed countries.
“To our knowledge, this is the first study to directly compare the cost and type of treatments, and health outcomes, in two comparable populations that are evolving in different health systems,” says the lead author of the study Todd Yezefski of Seattle’s Fred Hutchinson Cancer Research Center.
Several points remain, however, to be specified
The study is not perfect and must be completed, especially since the group of Canadian patients (1,622 people) studied was older and more numerous than the American group (575 patients), due to a lack of access to data.
Further research will also be needed to assess possible differences in quality of life and side effects between these two populations. But this is beyond the scope of this study because this information is not available in the health data used here.
But, as the medical director of the American Society of Clinical Oncology (ASCO), Richard Schilsky, points out, “it gives a significant context to the current debate on the inflation of treatment costs”.