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

Colorectal cancer (CRC) is a leading cause of cancer-related death and among the costliest cancers to treat in the United States. As advanced-stage diagnoses rise, the initial-care cost differences between metastatic (mCRC) and non-metastatic CRC (non-mCRC) remain unclear, limiting insight into the financial impact of metastasis and late detection. Using Optum's de-identified Clinformatics® Data Mart, the largest U.S. commercial claims database, we examined first-year costs of care for patients aged ≥45 newly diagnosed with CRC between 2017 and 2023, with at least one 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 (OOP) 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 mCRC patients, 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. 84.0%), radiation therapy, and hospice care. Medical and prescription charges for mCRC patients ($353,255 and $5,745) were nearly double those for non-mCRC ($182,000 and $2,406), as were OOP 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 mCRC patients. These findings underscore the economic burden of metastasis, highlighting potential benefits and cost savings of early detection and intervention strategies such as routine screening.