Objective: The COVID pandemic has had a significant impact on the US health care system. Our primary objective was to understand the impact of the COVID pandemic on non–COVID-related health care utilization among insured individuals with chronic conditions. Our secondary objective was to examine the differential impact by individual characteristics. Main Data Source: Medical and pharmacy claims data for individuals enrolled in a large insurer across the United States. Research Design: A retrospective and repeated cross-sectional study. Overall and condition-specific health care utilization and cost metrics in (1) March 1 to June 15 and (2) June 16 to September 30, 2020 were compared with the same months during 2016–2019. Subjects: Members of all ages with a diagnosis of diabetes, cardiovascular disease, or chronic kidney disease with commercial or Medicare Advantage insurance. Results: Most non–COVID-related health care utilization decreased drastically on March 1 to June 15, 2020 [odds ratio (OR) range across condition-specific tests: 0.55–0.69; incidence rate ratio (IRR) range for hospitalization/emergency department (ED) visit/outpatient visit: 0.65–0.77] but returned to closer to pre-COVID levels by June 16 to September 30, 2020 [OR range across condition-specific tests: 0.93–1.08; IRR range for hospitalization/ED visit/outpatient visit: 0.77–0.97]. Our study found an enormous increase in telehealth use on March 1 to June 15, 2020 (90–170 times prepandemic levels). A differential impact was observed by age, sex, region of residence, and insurance type. Implications: Further investigation is needed to assess the impact of these changes in health care utilization on long-term health outcomes.

430 Background: Anticancer drug regimens that are approved by accepted drug compendia and also considered high value based on their efficacy, toxicity, and costs are designated as “on-pathway” for a national commercial payer. This study compared quality and cost of cancer care among patients with metastatic solid tumors treated in the first line setting who were prescribed on- vs. off-pathway regimens. Methods: Using administrative claims data and prior authorization data from a national commercial payer, we identified 8,357 commercially insured or Medicare Advantage adult patients with solid tumor cancers including breast, lung, colorectal, pancreatic, melanoma, kidney, bladder, gastric, or uterine cancer, who were prescribed first-line anti-cancer regimens in the metastatic setting from 2018 to 2021. Patients were classified into on- vs. off pathway group based on the initial anticancer regimen that was prescribed. On-pathway status was prospectively defined by a panel of practicing oncologists based on review of curated evidence and general application of relative clinical value frameworks accepted in the field. We compared post–6-month quality-of-care outcomes including chemotherapy-related avoidable hospitalizations, emergency room (ER) visits, immune-related adverse events (IRAEs) such as endocrinopathies owing to immune checkpoint inhibitors, need for supportive drugs such as granulocyte colony stimulating factor, and cost outcomes between groups. Generalized linear models were used to assess the association between on-pathway regimens and outcomes adjusting for key patient demographics, clinical and provider characteristics. Results: A total of 5,453 (65.3%) patients were prescribed on-pathway regimens. Both groups had similar age (60.1 vs. 59.6, p = 0.06) and ECOG performance status (0.63 vs. 0.62, p = 0.40), with more females in the off-pathway group (54.6% vs. 57.3%, p = 0.02). There was no statistically significant difference in chemotherapy-related avoidable hospitalizations, IRAEs and need for supportive drugs between the two groups after modeling adjustment. However, patients treated on-pathway had higher rates of chemotherapy-related avoidable ER visits (18% vs. 15%, adjusted odds ratio: 1.16, 95% confidence interval (CI): 1.01 to 1.33, p = 0.03). Patients in the on-pathway group had significantly lower 6-month anticancer treatment cost (adjusted cost difference: -$10410, 95% CI: -$14935 to -$5886, p < 0.01), resulting in an overall lower total healthcare costs (adjusted cost difference: -$12826, 95% CI: -$18879 to -$6773, p < 0.01). Conclusions: Pathway regimens for metastatic solid tumors were associated with reduced total healthcare costs and similar quality of care compared with off-pathway regimens. These findings support the use of high value, evidence-based regimens for metastatic cancer patients.

7 Background: Rising healthcare costs have garnered interest from payers in shifting oncology care towards a value-based practice model. Pathways are a subset of evidence-based guidelines designed to standardize cancer drug prescribing by clarifying decisions along three priorities: efficacy, safety, and cost. However, the major predictors of compliance with clinical pathway recommendations are unknown. Methods: We conducted a retrospective cohort study using administrative claims linked with prior authorization data of Anthem commercial and Medicare Advantage members. We identified members aged 18 or older with a diagnosis of breast, lung, colorectal, bladder, kidney, uterine, pancreatic cancer or melanoma being treated with a first-line treatment regimen in the metastatic setting between July 2018 and October 2021. The primary outcome was pathway compliance (PC), defined as whether a patient’s anti-cancer drug regimen is also an Anthem pathway-endorsed regimen. We built a logistic regression model with stepwise backward selection to identify patient, physician, practice, geographic, and temporal factors that were associated with PC. Results: The cohort comprised 17,584 patients in total. The treatment period yielded 11,277 (64%) observations of patients with PC (48.1% male, mean [SD] age 60.7 years [11]) and 6,307 (36%) without PC (45.1% male, mean [SD] age 60.4 years [11.6]). In adjusted analyses, we find that the odds of PC decrease over time and with variation by malignancy. Any inpatient (OR = 1.32, 95% CI 1.22 – 1.43) or emergency room utilization (OR = 1.21, 95% CI 1.12 – 1.31) in the baseline 6-month period was associated with a higher odds of PC. Conversely, doubling total medical costs in the preceding 6 months was associated with lower odds of PC (OR 0.86, 95% CI 0.83 – 0.88). The odds of PC increased with a higher share (median or above vs below median) of Anthem patients per physician (OR 1.12, 95% CI 1.04 – 1.20). Finally, Oncology Care Model participation was associated with higher odds of PC (OR = 1.13 95% CI 1.04 – 1.23). Conclusions: Among patients treated in the first-line setting for metastatic disease, PC was observed in slightly under two-thirds of cases and was associated with the penetration of Anthem patients in the practice. Participation in OCM was also associated with increased PC. These findings would be of interest to policymakers focused on value-based cancer care.

398 Background: Between March 2017 and May 2020, ten new systemic medication therapies for hepatocellular carcinoma (HCC) were approved for the US market. However, clinical trials for medications only showed marginal improvement in health outcomes compared to placebo or sorafenib, the only medication previously approved for HCC. The objective of this study was to examine the change in treatment patterns and outcomes of incident patients with HCC before and after multiple medication approvals. Methods: This observational cohort study used administrative medical and pharmacy claims data for adult commercially insured and Medicare Advantage patients with at least two diagnoses of HCC during July 2013 to December 2020. Patients were categorized into two groups: the pre-approval group (identified between July 2013 and March 2017) and the post-approval group (identified between April 2017 and December 2020). We compared systemic therapy treatment (e.g., sorafenib and lenvatinib) patterns, survival, hospitalization for serious infections, other treatments such as G-CSF use and liver transplants, and cost (e.g, total all-cause costs and anti-HCC systemic therapy). Generalized linear model and Cox proportional hazards regression were used to assess the effect of new approvals on outcomes while controlling for baseline characteristics. Results: We identified 2,730 patients in the pre-approval group and 2,290 patients in the post-approval group. After risk adjustment, the latter was more likely to use systemic therapy medications (20.4% vs. 13.7%, adjusted odds ratio [aOR] 1.41, 95% confidence interval [CI] 1.22-1.62). Overall survival remained similar between the two groups (adjusted hazard ratio [HR] 0.96, 95% CI 0.87-1.06) and among the subsets who used systemic therapy (aHR 1.10, 95% CI 0.91-1.32). Odds of liver transplant (aOR 1.03, 95% CI 0.80-1.34) and hospitalization for serious infections (aOR 0.95, 95% CI 0.87-1.09) were similar, while the post-approval group had lower odds of G-CSF use (aOR 0.59, 95% CI 0.48-0.73). No differences in total per-member-per-month (PMPM) costs were seen, but the post-approval group had lower PMPM pharmacy-related costs (adj cost diff -$1,188, 95% CI -$1,575 to -$755) and higher PMPM systemic therapy costs (adj cost diff $971, 95% CI $584 to $1446). Conclusions: As expected, use of newer systemic therapies in HCC patients increased following approval of new medications. However, there was no associated change in clinical outcomes such as survival or serious infections, providing additional real-world evidence of marginal improvement, if any. Pharmacy costs decreased in the post-approval group, which may reflect a shift from oral sorafenib to newer injectable systemic therapies.