Impact of Cachexia on Resource Utilization and Costs in Patients with Pancreatic, Lung, and Colorectal Cancers

Abstract

Introduction: Cancer cachexia or cancer anorexia-cachexia syndrome (CACS) is a wasting disease characterized by inadequate food intake, loss of muscle mass, weight loss, inactivity, and changes in metabolism. Cachexia is estimated to affect 70-80% of pancreatic cancer patients and approximately 50% of lung and colorectal cancer patients. There is limited literature describing the impact of this condition on healthcare resource utilization and costs in the US. Objective: The primary objective of this study was to compare the healthcare resource utilization (HRU) and direct health plan costs of colorectal, lung, and pancreatic cancer patients diagnosed with cachexia to matched cancer patients without a cachexia diagnosis. Methods: We conducted a retrospective cohort study in commercial and Medicare Merative™ MarketScan® claims database. Patients with cachexia were identified following a colorectal, lung, or pancreatic primary cancer diagnosis between October 1st, 2016 – December 31st, 2022. Controls with no cachexia diagnosis during the study period were 2:1 matched with cachexia cases. Mean annual healthcare resource utilization and direct health plan costs were calculated using Kaplan-Meier Sample Average (KMSA) to account for patients censored before the end of the 1-year observation period. Significant differences between groups were determined by bootstrap 95% confidence intervals. A cox proportional hazard model was conducted in the unmatched cohort to determine relative hazard of cachexia diagnosis in different cancer types. Results: After matching the sample included 34,882 cancer patients, 11,880 in the cachexia cohort and 23,002 in the control cohort. Overall healthcare costs were significantly higher in colorectal, lung, and pancreatic cancer patients with cachexia ($141,626, [95% CI: $138,004 - $144, 905]) compared to those without evidence of cachexia, ($99,104, [95% CI: $97,193 – $101,224]). Average annual hospital admissions (cachexia: 0.98 admissions, [95% CI: 0.94 – 1.02]; control: 0.60, [0.58 – 0.62]) and annual emergency room visits, (cachexia: 2.47 ER visits [95% CI: 2.38 – 2.58]; control: 1.33 [95% CI: 1.29 – 1.36]) were significantly higher among cancer patients with cachexia compared to controls. Average annual outpatient encounters (cachexia: 61.5 encounters [95% CI: 60.7 – 62.4]; control: 44.6 [95% CI: 44.0 – 45.2]) and annual prescription fills (cachexia: 37.7 fills [95% CI: 37.1 – 38.4]; control: 30.4 [95% CI: 30.0 – 30.8]) were also significantly higher in cachexia cancer patients compared to controls. Among patients who developed cachexia, pancreatic cancer patients had the shortest median time to cachexia diagnosis of 1.2 months (IQR: 0.1 - 5.1) and had a 2.9-fold greater risk of being diagnosed with cachexia compared to those with colorectal cancer, which had the lowest hazard (HR: 2.90, [95% CI: 2.79 – 3.02, p<0.0001]). Conclusion: Colorectal, lung, and pancreatic cancer patients in the US, with a concurrent diagnosis of cachexia were found to have higher healthcare resource utilization and cost of care in the year following cachexia diagnosis.