Initial-Care Medical and Prescription Costs for Incident Metastatic versus Nonmetastatic Colorectal Cancer

Colorectal cancer is a leading cause of cancer-related death and among the costliest cancers to treat in the United States. As advanced-stage diagnoses increase, the initial-care cost differences between metastatic (mCRC) and nonmetastatic colorectal cancer (non-mCRC) remain unclear, limiting insights into the financial impact of metastasis and late detection. Using Optum's de-identified Clinformatics Data Mart, the largest US commercial claims database, we examined first-year costs of care for patients aged ≥45 years newly diagnosed with colorectal cancer between 2017 and 2023, with at least 1 year of medical records before and after diagnosis. Multivariate linear mixed-effects models estimated the impact of metastasis on medical and prescription charges and out-of-pocket expenses (2023 USD) in relation to treatment components, emergency department (ED) visits, hospitalizations, and hospice care. Among 25,169 patients, 32.8% had metastasis at diagnosis. Treatment and care utilization were consistently higher for patients with mCRC, with the greatest disparity in pharmacotherapy use (79.1% vs. 26.9%), followed by ED visits (65.4% vs. 48.1%), hospitalizations (91.1% vs. 84%), radiotherapy, and hospice care. Medical and prescription charges for patients with mCRC ($353,255 and $5,745) were nearly double than those for non-mCRC ($182,000 and $2,406), as were out-of-pocket expenses ($4,032 vs. $2,144 for medical; $319 vs. $188 for prescriptions). Pharmacotherapy was the primary cost driver in mCRC, followed by hospitalizations and ED visits. Initial-care medical and prescription costs were substantially higher for patients with mCRC. These findings underscore the economic burden of metastasis, highlighting potential benefits and cost savings of early detection and intervention strategies such as routine screening.

This study highlights the substantial economic burden of mCRC, with medical and prescription costs nearly twice those of nonmetastatic cases. The findings underscore the financial and clinical benefits of early detection and timely intervention, reinforcing the importance of routine colorectal cancer screening to reduce late-stage disease incidence.