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Effect of a Pay-for-Performance Program on Prescriptions and Spending for Oncology Drugs


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In a study reported in the Journal of Clinical Oncology, Justin E. Bekelman, MD, and colleagues found that institution of a national insurer’s pay-for-performance program resulted in a higher rate of prescriptions for evidence-based oncology drug regimens but did not reduce overall health-care spending.

Justin E. Bekelman, MD

Justin E. Bekelman, MD

Study Details

The study involved HealthCore data from the national insurer Anthem, covering approximately 6.7% of adults in the United States. Anthem instituted a voluntary pay-for-performance program in 14 states between 2014 and 2015. The study included a total of 25,042 adult patients with breast, colon, or lung cancers who were prescribed cancer drugs by a total of 1,867 physicians in the 14 states between July 2013 and September 2017, with follow-up through March 2018. The primary outcome was whether a patient’s prescribed drug regimen was a program-endorsed, evidence-based regimen prior to vs after pay-for-performance institution. Spending (in 2018 U.S. dollars) during the preintervention vs intervention periods was evaluated over a 6-month episode period after an index drug claim, with data showing 6-month spending per patient.

Key Findings

Over the study period, 1,867 (97%) of 1,928 eligible physicians participated in the pay-for-performance program and prescribed cancer drugs to 25,042 (96%) of eligible patients.

The pay-for-performance program was associated with an increase in evidence-based regimen prescribing to 62.2% of patients in the intervention period from 57.1% of patients in the preintervention period (difference = 5.1 percentage points, 95% confidence interval [CI] = 3.0 percentage points–7.2 percentage points, P < .001).

The pay-for-performance program was associated with a differential $3,339 increase (95% CI = $1,121–$5,557, P = .003) in cancer drug spending per patient, from $48,030 to $51,369, over the 6-month episode period.  

The program was associated with a differential $253 increase (95% CI = $100–$406, P = .001) in patient out-of-pocket spending—from $2,217 to $2,470—over the 6-month period.

There was a nonsignificant differential $525 decrease (95% CI = -$2,505–$1,455, P = .603) in non–cancer drug health-care spending, from $47,909 to $47,384.

There was a nonsignificant differential $2,772 increase (95% CI = -$181–$5,725, P = .07) in total health-care spending, from $95,740 to $98,512.

The investigators concluded: “Pay-for-performance programs may be effective in increasing evidence-based cancer drug prescribing but may not yield cost savings.”

Dr. Bekelman, of the University of Pennsylvania Perelman School of Medicine, is the corresponding author for the Journal of Clinical Oncology article.              

Disclosure: HealthCore’s work was funded by Anthem. For full disclosures of the study authors, visit ascopubs.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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