Cost drivers of locally advanced rectal cancer treatment—An analysis of a leading healthcare insurer

Abstract

Background To evaluate the economic burden of locally advanced rectal cancer (LARC) treatment from a society perspective through analysis of health insurance‐derived data of commercially insured and Medicare Advantage (MA) patients. Methods Retrospective cost analysis of patients undergoing rectal resection within a multimodal (neoadjuvant chemoradiation + adjuvant chemotherapy) treatment strategy between January 1, 2010 and October 31, 2018, using the claims OptumLabs Data Warehouse database. Results In total, 1738 (935 commercial and 803 MA) patients were included. Overall treatment costs totaled $230,881,746 (on average $183 653 ± 82 384 per commercially insured and $73 681 ± 32 917 per MA patient). Cost distribution according to category (commercially insured patients) was: 29.92% related to outpatient care (follow‐up visits/diagnostics), radiotherapy: 21.83%, index resection: 20.62%, chemotherapy: 17.44%, surgical inpatient: 6.32%, medical inpatient: 3.28%, emergency room: 0.58%. Relative cost distribution of the index resection itself differed marginally between the three approaches and was 21.49% for open, 19.30% for laparoscopic, and 20.93% for robotic surgery. Relative cost distributions of neoadjuvant, adjuvant, and outpatient treatments remained unchanged, independently of the surgical approach. This representation was similar in MA patients. Conclusion Index‐surgery related costs were outweighed by costs related to oncological and outpatient workup/follow‐up treatments independently of both surgical approach and insurance type.

Association of opioid fills with centers for disease control and prevention opioid guidelines and payer coverage policies: physician, insurance and geographic factors

“…First-time opioid fills for patients were identified between January 1, 2014 and December 31, 2018 from OptumLabs® Data Warehouse (OLDW) [ 29 ] claims database, a nationwide claims database of de-identified administrative medical and pharmacy claims for commercial and MA enrollees containing information on over 100 million enrollees [ 30 ]. The database contains longitudinal health information on enrollees and patients, representing a mix of ages, ethnicities, and geographical regions across the United States.…”

Improving Value in Surgery

“…Radiation and chemotherapy account for nearly 40% of the total cost of treatment for rectal cancer. 14 Standard courses of neoadjuvant chemoradiation therapy and adjuvant chemotherapy are estimated to cost $25,000 and $20,000, respectively. Overtreatment not only wastes costs on neoadjuvant therapy, but also costs for subsequent, mandatory adjuvant chemotherapy administered to patients whose initial tumor may have been over-staged.…”

“…Loop ileostomies cause defects in value from hospital readmissions, expenses for nursing support and stoma supplies, and decreased quality of life. 14 Costs for subsequent loop ileostomy closures are also significant (Table 1). On the basis of National Comprehensive Cancer Network guideline recommendations for neoadjuvant therapy for all clinical stage II and III patients and mandatory fecal diversion in treated patients, 24,750 loop ileostomies would be created annually.…”

“…Radiation and chemotherapy account for nearly 40% of the total cost of treatment for rectal cancer 14. Standard courses of neoadjuvant chemoradiation therapy and adjuvant chemotherapy are estimated to cost $25,000 and $20,000, respectively.…”

“…Fewer patients treated with neoadjuvant therapy can also reduce the number of loop ileostomies created, as most surgeons consider fecal diversion mandatory in radiated patients. Loop ileostomies cause defects in value from hospital readmissions, expenses for nursing support and stoma supplies, and decreased quality of life 14. Costs for subsequent loop ileostomy closures are also significant (Table 1).…”