Lung and colon cancer costs among chemotherapy patients after an FDA policy change.

Abstract

e14578 Background: Emerging evidence of adverse events from erythropoietin-stimulating agents (ESAs) led FDA to add a black box warning to ESA labeling in March 2007, after which ESA use declined. We examined the impact on healthcare costs for lung and colon patients receiving chemotherapy in Department of Veterans Affairs (VA) healthcare facilities. Methods: Patients were newly diagnosed with lung or colon cancer during 2002-2008, had at least 2 chemotherapy visits, and did not have kidney disease. For each patient, we defined a chemotherapy episode as the time beginning with the first chemotherapy visit and ending with the last visit before a break of 90 days with no chemotherapy. We calculated outpatient anemia management (ESA and transfusion), cancer-related, and total healthcare costs from 30 days before to 90 days after the chemotherapy episode. We compared costs between patients with chemotherapy episodes before (PRE) and after (POST) March 2007 using multivariable regression analyses controlling for patient and facility characteristics. Costs were adjusted to 2010 dollars using the consumer price index. Results: There were 16,828 study patients: 13,630 lung and 3,198 colon. POST-period ESA use was markedly lower than PRE-period use for both groups (lung, 23% vs. 39%, P<0.01; colon, 11% vs. 23%, P<0.01). More lung cancer patients received transfusions in the POST than the PRE period, though the increase was small (27% vs. 25%, P=0.04). Consequently, adjusted POST-period anemia treatment costs were lower (lung, $526 lower, P<0.01; colon, $504 lower, P<0.01). Cancer-related and total costs were nonetheless higher in the POST period, due primarily to higher outpatient costs (adjusted cancer-related costs: lung, $4,500 higher, P<0.01; colon, $10,343 higher, P<0.01; adjusted total costs: lung, $4,706 higher, P<0.01; colon, $11,414 higher, P<0.01). Conclusions: Outpatient anemia management costs were lower during the period after the FDA policy change. There was no substitution effect of transfusion in place of ESAs. These declines in anemia management costs were not enough to offset the higher cancer-related costs, resulting in higher total healthcare costs.