Association between cachexia-associated diagnoses, health care resource utilization, and costs in patients with pancreatic, lung, and colorectal cancers: A US insurance claims database analysis

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.