In a study reported in JAMA Oncology, Ravi B. Parikh, MD, MPP, and colleagues found that a large commercial payer’s utilization management policy was associated with increased use of hypofractionated radiotherapy among eligible women with early-stage breast cancer.
The investigators noted, “Although hypofractionated radiotherapy after breast-conserving surgery is a cost-effective and convenient treatment strategy for patients with early-stage breast cancer, less than 40% of eligible women received hypofractionated radiotherapy in 2013.”
“This study suggests that a payer’s utilization management policy was associated with direct and spillover increases in the use of hypofractionated radiotherapy, even after accounting for a long-term secular trend in the uptake of hypofractionated radiotherapy in the control groups. Utilization management may promote evidence-based cancer care.”— Ravi B. Parikh, MD, MPP, and colleagues
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Study Details
The study involved data from January 2012 to June 2018 from women with early-stage breast cancer who were eligible for hypofractionated radiotherapy according to 2011 American Society for Radiation Oncology guidelines and were continuously enrolled in 14 geographically diverse commercial health plans. Data were obtained from the HealthCore Integrated Research Environment, a repository of medical and pharmacy claims data for members managed by the commercial health plans. Beginning on January 1, 2016, the payer instituted a utilization management policy to encourage use of hypofractionated radiotherapy among women in fully insured and Medicare Advantage (fully insured) plans. Under the plan, claims for extended-course radiotherapy were not reimbursed for fully insured women who were eligible for hypofractionated radiotherapy. The policy did not apply to women in self-insured or Medicare supplemental insurance (self-insured) plans.
Key Findings
Among a total of 10,540 eligible women, 3,619 (34.3%) were in fully insured plans subject to the policy. Among the fully insured patients, the adjusted probability of receiving hypofractionated radiotherapy increased from 39.6% in the prepolicy period to 72.9% in the postpolicy period, yielding a 33.3% difference. Among the self-insured patients, the probability increased from 41.3% to 70.4%, yielding a difference of 29.1%. Adjusted difference-in-difference analysis showed an absolute increase of 4.2% (P = .05) for fully insured vs self-insured patients.
Pre- to postpolicy cost of radiotherapy per patient in 2016 U.S. dollars decreased by $5,606 for fully insured patients and by $3,331 for self-insured patients, with the adjusted difference-in-difference of $2,275 not being significant (P = .09).
In a spillover analysis involving self-insured patients indirectly exposed to the policy by being linked with clinicians who treated fully insured patients, such patients exhibited a significantly higher uptake of hypofractionated radiotherapy vs self-insured patients not exposed to the policy (adjusted difference-in-difference = 8.5%, P < .001).
The investigators concluded, “This study suggests that a payer’s utilization management policy was associated with direct and spillover increases in the use of hypofractionated radiotherapy, even after accounting for a long-term secular trend in the uptake of hypofractionated radiotherapy in the control groups. Utilization management may promote evidence-based cancer care.”
Dr. Parikh, of the Perelman School of Medicine, University of Pennsylvania, is the corresponding author for the JAMA Oncology article.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
