Evidence-Based Anticancer Drug Use in Physician Offices vs Hospital Outpatient Facilities

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In a study reported in JCO Oncology Practice, Fishman et al found no significant difference in the use of optimal evidence-based anticancer drug regimens in physician offices vs hospital-based outpatient departments. However, the investigators found significantly higher costs of treatment in the hospital outpatient setting.

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Study Details

The study involved data for 2013 to 2017 from patients with breast, lung, or colorectal cancer in a large health insurance database. Anticancer drug regimens were considered to be “on pathway” if they were on the payer’s program list of optimal regimens when treatment was administered.

Anticancer drug–related costs included all patient- and plan-paid costs on claims for anticancer drugs over the 6-month period following the date of the initial cancer drug claim (index date). Total cost was defined as the sum of all patient- and plan-paid dollars in medical claims in the 6 months after the index date.

Key Findings

A total of 38,140 patients were included in the analysis, with 18,998 receiving treatment at physician offices and 19,142 receiving treatment at hospital-based outpatient departments.

Treatment was on pathway for 59.5% of patients treated at hospital-based outpatient departments vs 60.8% of patients treated at physician offices (P = .069).

Adjusted cancer drug-related costs per patient were $63,763 at hospital-based outpatient departments vs $36,500 at physician offices (P < .001). Adjusted total costs per patient were $115,843 vs $77,346 (P < .001). Among the 5% to 7% of patients with Medicare Advantage, adjusted total costs per patient were $61,812 for hospital-based outpatient departments vs $62,769 for physician offices, and adjusted drug-related costs per patient were $31,610 vs $33,168. Among patients with commercial insurance, total costs were $119,288 vs $77,613 and drug-related costs were $65,930 vs $36,366.

The investigators concluded, “Total and cancer drug–related per-patient costs were higher in hospital-based outpatient departments vs physician offices, but on-pathway status was similar. The cost differential between hospital-based outpatient departments and physician offices was driven by commercially insured members rather than Medicare Advantage members.”

Ezra Fishman, PhD, of the National Committee for Quality Assurance, Washington, DC, is the corresponding author for the JCO Oncology Practice article.

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