Abstract 65P
Background
TTo estimate hospital resource utilization and costs of treating metastatic colorectal cancer (mCRC) patients according to international guidelines.
Methods
The RAXO study included mCRC patients 2012-2018, scheduled for antitumour therapy. For this substudy, cost data from the six largest Finnish hospital districts (n=941) in RAXO were collected from mCRC diagnosis to death or the end of 2021. All patient*s were characterized day-by-day to diagnostic, curative, remission, palliative chemotherapy, treatment break, or end-of-life phases. The costs, in 2021 euros, and resource utilization were calculated per patient per month (PPPM).
Results
The mean PPPM cost for treating mCRC patients with a mean survival of 37 months was 2,323€, when 37% had curative-intent metastasectomy. Each month included mean 0.7 ward days, 1.9 outpatient and 0.1 emergency visits. Sixty-three percent of costs were from outpatient care and 34% from inpatient care. Most visits (mean 4.4) were during the mean 2.5-month diagnostic phase. During the 21-month curative treatment of metastases phase, 19-month palliative chemotherapy phase, and the 2-month end-of-life phase, the mean number of visits was 3.3, decreasing to 1.2 during the 8-month treatment break, and 0.8 during the 35-month remission phase. Inpatient costs accounted for 72% of the diagnostic phase, 50% of the curative phase, 17% of the palliative chemotherapy phase, and 63% of the end-of-life phase costs. The higher costs during active treatment (2,963–3,059€/PPPM) were balanced by lower costs during remission and treatment breaks (453–560€/PPPM). Pharmacy, ward, operating room, and outpatient costs (39%/18%/15%/15%, respectively) were the main drivers for internal hospital billing.
Conclusions
Costs, resource utilization, and cost drivers varied 8-fold between disease phases. Outpatient care, including pharmaceutical treatment, accounted for two-thirds and inpatient care, including surgery, accounted for one-third of overall costs during the mCRC disease trajectory. This study provides a new perspective on resource utilization and costs during curative and palliative phases determined using detailed clinical data.
Clinical trial identification
NCT01531621, EudraCT 2011-003158-24.
Legal entity responsible for the study
Helsinki University Hospital.
Funding
This investigator-initiated study was supported by Finska Läkaresällskapet, The Finnish Cancer Foundation, Relander´s foundation, the Competitive State Research Financing of the Expert Responsibility Area of Tampere, Helsinki, Turku, Kuopio, Oulu, and Satakunta Hospitals, Tampere University Hospital Fund, Helsinki University Hospital research fund, Mary and Georg C. Ehrnrooth Foundation, Liv & Hälsa and the infrastructure with the database and study nurses partly supported by pharmaceutical companies: Amgen-unrestricted grant, Eli Lilly and Company, Merck KGaA, Roche Oy, Sanofi, and Servier-unrestricted grant.
Disclosure
P.J. Osterlund: Financial Interests, Personal, Advisory Board, Also invited speaker: Amgen; Financial Interests, Personal, Advisory Board, Also invited speaker: AstraZeneca, MSD, BMS; Financial Interests, Personal, Advisory Board, Also invited lecturer: Bayer, Pierre Fabre; Financial Interests, Personal, Invited Speaker: Eisai, Fresenius Kabi, Imedex; Financial Interests, Personal, Advisory Board: Merck, Sanofi, Incyte, Daiichi Sankyo/AstraZeneca, Eisai, Jansen Pharmaceutica; Financial Interests, Personal, Invited Speaker, Roche Finland and Sweden: Roche; Financial Interests, Personal, Invited Speaker, No compensation for advisory boards: Servier; Financial Interests, Personal, Invited Speaker, Also via Medicom: Nordic Drugs/Group; Financial Interests, Personal, Expert Testimony, FIMEA expert testimony: BMS; Financial Interests, Personal, Invited Speaker, Nordic guidelines committee: Danone; Financial Interests, Institutional, Research Grant: Amgen, Servier, Nordic Drugs/Group; Financial Interests, Institutional, Invited Speaker: Incyte, Roche, Pfizer; Non-Financial Interests, Member: Colores patient advocacy group; Non-Financial Interests, Member, Board member: Finnish Cancer Society. J. Kontiainen: Financial Interests, Institutional, Research Grant: Roche, Merck, Servier, Sanofi, Amgen, Lilly, Nordic Drugs/Pharma. K.I. Lehtomaki: Financial Interests, Institutional, Research Grant: Amgen, Merck, Roche, Sanofi, Servier, Eli Lilly, Nordic Drugs/Pharma; Financial Interests, Personal, Expert Testimony: Bayer; Financial Interests, Personal, Expert Testimony, Invited speaker: Roche; Financial Interests, Personal, Expert Testimony, Invited speaker: Amgen; Financial Interests, Personal, Invited Speaker: Servier, Pfizer, AstraZeneca. T.T. Muhonen: Financial Interests, Institutional, Research Grant: Amgen, Roche, Merck, Sanofi, Servier, Eli Lilly. E. Heerva: Financial Interests, Personal, Advisory Board: Amgen, Merck, Roche, Servier; Financial Interests, Institutional, Other, Institutional grant: Eli Lilly; Financial Interests, Institutional, Other, Institutional grant: Sanofi. A. Algars: Financial Interests, Personal, Research Grant: Amgen, Roche, Servier, Sanofi, Merck, Eli Lilly. R. Ristamaki: Financial Interests, Institutional, Research Grant: Amgen, Merck, Roche, Sanofi, Servier, Lilly. H.P. Stedt: Financial Interests, Institutional, Research Grant: Amgen, Roche, Sanofi, Lilly, Merck, Servier. A. Lamminmäki: Financial Interests, Institutional, Research Grant: Lilly, Servier, Amgen, Roche, Sanofi, Merck. R. Kallio: Financial Interests, Institutional, Research Grant: Amgen, Roche, Lilly, Servier, Sanofi, Merck, Nordic Drugs/Pharma. T. Salminen: Financial Interests, Institutional, Research Grant: Nordic Pharma/Drugs, Amgen, Merck, Sanofi, Servier, Lilly; Financial Interests, Personal and Institutional, Invited Speaker, Research grant: Roche. E. Osterlund: Financial Interests, Personal and Institutional, Invited Speaker, Research grant: Amgen; Financial Interests, Institutional, Research Grant: Roche, Sanofi, Servier, Lilly; Financial Interests, Personal and Institutional, Research Grant, Travel grant: Nordic Pharma, Merck. S. Aho: Financial Interests, Institutional, Research Grant: Amgen, Roche, Sanofi, Servier, Lilly, Merck. M.T. Barlund: Financial Interests, Institutional, Research Grant: Nordi Drugs/Pharma. P. Halonen: Financial Interests, Institutional, Research Grant: Nordic Drugs/Pharma, Amgen, Sanofi, Lilly, Servier, Merck, Roche. L. Soveri: Financial Interests, Institutional, Research Grant: Amgen, Nordic Drugs, Servier, Lilly, Sanofi, Merck, Roche. A. Nordin: Financial Interests, Institutional, Research Grant: Merck, Servier, Amgen, Servier, Sanofi, Roche. A. Uutela: Financial Interests, Institutional, Research Grant: Merck, Amgen, Servier, Lilly, Sanofi, Roche. B. Glimelius: Financial Interests, Institutional, Research Grant: Amgen. H. Isoniemi: Financial Interests, Institutional, Research Grant: Amgen, Roche, Sanofi, Servier, AstraZeneca, Lilly, Merck.