Cost Differences Associated With Oncology Care Delivered in a Community Setting Versus a Hospital Setting: A Matched-Claims Analysis of Patients With Breast, Colorectal, and Lung Cancers

Abstract

QUESTIONS ASKED: Are there financial ramifications associated with the paradigm shift of cancer care delivery away from community-based clinics (CCs) and toward hospital-based oncology clinics (HCs)? Furthermore, are any cost differences also accompanied by care quality differentials as measured by hospitalizations or emergency department (ED) visits?ReCAPs (Research Contributions Abbreviated for Print) provide a structured, one-page summary of each paper highlighting the main findings and significance of the work. The full version of the article is available online at jop.ascopubs.org. AbstractPurpose Access to high-quality cancer care remains a challenge for many patients. One such barrier is the increasing cost of treatment. With recent shifts in cancer care delivery from community-based to hospital-based clinics, we examined whether this shift could result in increased costs for patients with three common tumor types. MethodsCost data for 6,675 patients with breast, lung, and colorectal cancer were extracted from the IMS LifeLink database and analyzed as cost per patient per month (PPPM). Patients treated within a community setting were matched (2 to 1) with those treated at a hospital clinic on the basis of cancer type, chemotherapy regimen, receipt of radiation therapy, presence of metastatic disease, sex, prior surgery, and geographic region. Approximately 84% of patients were younger than 65 years of age. ResultsMean total PPPM cost was significantly lower for patients treated in a community-versus hospital-based clinic ($12,548 [standard deviation {SD},$10,507] v $20,060 [SD, $16,555]; P , .001). The PPPM chemotherapy cost was also significantly lower in the community setting ($4,933 [SD,$4,983] v $8,443 [SD,$10,391]; P , .001). The lower cost observed in community practice was irrespective of chemotherapy regimen and tumor type. ConclusionWe observed significantly increased costs of care for our patient population treated at hospital-based clinics versus those treated at community-based clinics, largely driven by the increased cost of chemotherapy and provider visits in hospital-based clinics. If the site of cancer care delivery continues to shift toward hospital-based clinics, the increased health care spending for payers and patients should be better elucidated and addressed.

Use of Optimal Evidence-Based Anticancer Drug Regimens in Physician Offices Versus Hospital Outpatient Facilities

“…Previous research has shown that, compared with HOPDs, a smaller proportion of patients receiving chemotherapy in MDOs had an emergency department visit within 72 hours of drug therapy administration, while also having substantially lower per-patient costs. 11 Our findings build on that work by providing a comprehensive measure of quality of care-one that measures the quality of cancer drug treatments. Furthermore, we that the higher cost for patients treated at HOPDs was a feature of patients with commercial insurance, but not those with Medicare Advantage, who face similar costs regardless of where they get their treatment.…”

“…10 It is well established that cancer care is costlier per patient in HOPDs than in MDOs. [10][11][12] However, little is known about whether the quality of that care differs between the treatment sites.…”

A cost comparison study to review community versus acute hospital models of nursing care delivered to oncology patients

“…Rischin et al used direct and indirect costs based on services received and found that the average chemotherapy treatment was $83 more expensive to deliver in the community than in hospital (Rischin et al, 2000). Gordan et al discovered a significant decrease in cost per patient per month when delivering care in community oncology clinics compared to hospital clinics, primarily driven by the increased cost of chemotherapy and provider visits in hospital-based clinics (Gordan et al, 2018). No previous study of this kind has used the precise, micro-costing method of cost collection used in this study.…”

“…Initiatives in USA (Lowenthal et al, 1996), Australia (Rischin et al, 2000) and in the United Kingdom (Hall and Lloyd, 2008) have shown success, in terms of patient preference, quality of care and cost, in moving oncology care services from secondary to a primary care setting. A recent study in USA has shown a decreased patient expense for those receiving oncology care in primary care rather than in secondary care setting (Gordan et al, 2018).…”

Implementation and Impact of Choosing Wisely Recommendations in Oncology

“…However, a matched-claims analysis of patients with breast, colorectal, and lung cancers found an increased cost of care in patients treated at hospital-based clinics versus community-based clinics. 56 Therefore, our findings may be influenced by the available databases in the community versus academic settings. Furthermore, many recommendations require assessment of individual patient's clinical context and status, patient expenses, third-party payer compensation, and billing data for different providers.…”