What's the Advantage?

• Author: Russell, Sabin
• Position: ECONOMIC OBSERVER - Comparison of colorectal cancer care

IN A COMPARISON of cancer care in neighboring regions of the U.S. and Canada, a study by scientists at Fred Hutchinson Cancer Research Center and colleagues from Vancouver, British Columbia, found Americans were paying twice as much for similar colorectal cancer treatments, with no advantage in survival rates. It is well known that the U.S. spends far more on health care than its neighbor to the north. However, the findings may be the first to measure costs and survival rates for a specific disease among demographically similar groups treated in the two countries.

"Beyond the chemotherapy costs, which you could imagine are going to be higher here, the novel piece is around treatments and survival," says senior author Veena Shankaran, a member of the Hutchinson Institute for Outcomes Research (HICOR). "It is not a complex study conceptually, but enlightening when you put numbers to it."

Among patients newly diagnosed with metastatic colorectal cancer, the study found average per-patient costs across all chemotherapy treatments were $12,345 per month in western Washington state and $6,195 per month in neighboring British Columbia--and "overall survival was no different between the two locations."

Metastatic colorectal cancer, in which cancer cells have spread to other parts of the body, is particularly deadly, although chemotherapy treatments do extend survival time for most patients. Median survival times for patients starting treatment during the study period was 21.4 months in Washington, 22.1 months in the Canadian province.

HICOR researchers looked at private insurance data from 13 counties in the Seattle region, while researchers at BC Cancer Agency in Vancouver analyzed data from the Canadian province, which operates a single-payer system like Medicare in the U.S., but covering all of its citizens.

The study showed that chemotherapy was more likely to be provided in the U.S--in 79% of patients compared to 68% of those in Canada. The study does not address why fewer patients were treated in Canada, although the BC patients as a group were older than those in the U.S. Among those who were not treated with chemotherapy, survival was substantially shorter, but also similar between the two regions: 5.4 months in Western Washington and 6.1 months in BC.

Studies comparing the two health systems are difficult to do because laws governing privacy effectively bar sharing patient data across international lines. However, this study was made...