Abstract
Background
Cancer cachexia is a wasting disease characterized by changes in metabolism, muscle and weight loss, inadequate food intake, and functional decline. The disease affects 30%-50% of patients with solid tumors. There is limited literature describing the relationship between cachexia and health care resource utilization (HRU) and costs in the United States.Objective
To compare the HRU and direct health plan costs for patients with colorectal, lung, and pancreatic cancer with and without a cachexia-associated diagnosis.Methods
We conducted a retrospective cohort study in Merative MarketScan commercial and Medicare claims databases. Patients with cachexia-associated diagnoses were identified following a colorectal, lung, or pancreatic cancer diagnosis between October 1, 2016, and December 31, 2022. Patients without a cachexia-associated diagnosis were propensity score-matched 2:1 to patients with a cachexia-associated diagnosis. Average 1-year HRU and direct health plan costs were calculated using a modified Kaplan-Meier sample average approach to account for patients lost to follow-up before the end of the 1-year observation period. The significance of group differences was assessed by nonoverlapping bootstrap 95% CIs.Results
The matched sample included 10,445 patients with a cachexia-associated diagnosis and 20,890 without across colorectal, lung, and pancreatic cancers. One-year health care costs were significantly higher for patients with a cachexia-associated diagnosis ($123,092; 95% CI = $119,664-$126,557) than for those without ($88,959; 95% CI = $86,964-$91,022). Patients with cachexia-associated diagnoses had significantly greater HRU than those without cachexia-associated diagnoses, including higher average 1-year hospital admissions (1.50; 95% CI = 1.47-1.53 vs 0.99; 95% CI = 0.97-1.01), emergency department visits (1.46; 95% CI = 1.42-1.50 vs 0.96; 95% CI = 0.93-0.98), outpatient visits (15.49; 95% CI = 15.15-15.83 vs 14.24; 95% CI = 14.02-14.46), and prescription fills (26.83; 95% CI = 26.31-27.35 vs 24.46; 95% CI = 24.11-24.80).Conclusions
Patients with colorectal, lung, and pancreatic cancer and cachexia-associated diagnoses had substantially higher 1-year HRU and cost of care compared with patients with cancer without cachexia-associated diagnoses. Our results highlight evidence of clinical and economic burden associated with cachexia-associated diagnoses in the US health care system.