David H Howard1, John Kauh, Joseph Lipscomb. 1. Department of Health Policy and Management, Emory University, Atlanta, GA 30030, USA. david.howard@emory.edu
Abstract
BACKGROUND: New chemotherapeutic agents for patients diagnosed with metastatic colorectal cancer have been singled out as examples of high-cost/low-value medical care. We measure trends in life expectancy and lifetime medical costs in this patient population between January 1, 1995, and December 31, 2005. METHODS: Using the Surveillance, Epidemiology, and End Results-Medicare database, we constructed a sample of 4665 patients aged 66 and older diagnosed with metastatic colorectal cancer between January 1, 1995, and December 31, 2005, who received chemotherapeutic agents. We estimated life expectancy and lifetime medical costs based on observed short-term survival rates and costs. RESULTS: Life expectancy increased by 6.8 months and lifetime costs by $37 100 (2006 dollars). The implied cost per life-year gained is $66 200 (95% confidence interval, $48 100-$84 200). After discounting life-years and costs and adjusting for patients' health utility and out-of-pocket payments, the cost per quality-adjusted life-year gained is $99 100 (95% confidence interval, $72 300-$125 900). CONCLUSIONS: New chemotherapeutic agents are associated with improvements in survival time but also with substantial costs. The cost-effectiveness ratio for these drugs as a group is below commonly cited estimates of the willingness-to-pay for a life-year. However, open-ended coverage policies for new chemotherapeutic agents may prove difficult to sustain as costs continue to rise.
BACKGROUND: New chemotherapeutic agents for patients diagnosed with metastatic colorectal cancer have been singled out as examples of high-cost/low-value medical care. We measure trends in life expectancy and lifetime medical costs in this patient population between January 1, 1995, and December 31, 2005. METHODS: Using the Surveillance, Epidemiology, and End Results-Medicare database, we constructed a sample of 4665 patients aged 66 and older diagnosed with metastatic colorectal cancer between January 1, 1995, and December 31, 2005, who received chemotherapeutic agents. We estimated life expectancy and lifetime medical costs based on observed short-term survival rates and costs. RESULTS: Life expectancy increased by 6.8 months and lifetime costs by $37 100 (2006 dollars). The implied cost per life-year gained is $66 200 (95% confidence interval, $48 100-$84 200). After discounting life-years and costs and adjusting for patients' health utility and out-of-pocket payments, the cost per quality-adjusted life-year gained is $99 100 (95% confidence interval, $72 300-$125 900). CONCLUSIONS: New chemotherapeutic agents are associated with improvements in survival time but also with substantial costs. The cost-effectiveness ratio for these drugs as a group is below commonly cited estimates of the willingness-to-pay for a life-year. However, open-ended coverage policies for new chemotherapeutic agents may prove difficult to sustain as costs continue to rise.
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