Patient-level costs of treating metastatic gastric cancer by treatment strategy.

Abstract

167 Background: Half of gastric cancer patients in North America present with metastatic disease. The appropriate management of these patients is complex and few guidelines exist to definitively guide treatment; as a result, practice variation exists. This variation may lead to care inefficiencies with adverse outcomes. We therefore aimed to conduct a patient-level exploration of metastatic gastric cancer management costs, by treatment strategy, and identify predictors of cost. Methods: We performed a patient-level cost analysis of metastatic gastric cancer patients diagnosed between 2005 and 2008 using a 26-month time horizon and the healthcare system’s perspective. Clinical data was derived from a provincial chart review. Costs associated with supportive care, radiation only, chemotherapy only, chemoradiation, gastrectomy, and gastrectomy with chemotherapy +/- radiotherapy were derived using administrative data from a universal healthcare system. Costs were inflated to 2017 United States dollars (USD) Linear regression was used to identify factors predictive of cost. Results: The absolute mean costs of metastatic gastric cancer management increased with increasing level of intervention and ranged from $34,002 to $72,778 (USD); supportive care was associated with the lowest costs and gastrectomy with chemotherapy +/- radiotherapy was associated with the highest costs. Age over 70 and lower Charlson Comorbidity Index were predictors of lower costs while supportive care, radiotherapy, chemoradiation, and gastrectomy were associated with higher costs. Conclusions: Practice variation has known clinical implications, but economic impact also needs to be considered. Variation in the management of metastatic gastric cancer may reflect dissimilar resource availability between health regions as well as differential access to palliative care. Evidence-based guidelines directing appropriate care for metastatic gastric cancer patients to reduce inefficiencies in care and governmental intervention to implement equitable resource allocation to bridge gaps in care are necessary.