Differences in Health Care Use and Costs Among Patients With Cancer Receiving Intravenous Chemotherapy in Physician Offices Versus in Hospital Outpatient Settings

Fisher, Mary L.; Punekar, Rajeshwari; Yim, Yeun Mi; Small, Arthur M.; Singer, Joseph; Schukman, Jay; McAneny, Barbara; Luthra, Rakesh; Malin, Jennifer L.

doi:10.1200/jop.2016.012930

Cited by 25 publications

(31 citation statements)

References 11 publications

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“…This phenomenon likely reflects structural differences between facility types. These findings echo the well‐documented shift in US cancer care from office practices to hospital‐affiliated outpatient centers and accompanying discussion regarding higher expenditures at these sites, especially among commercial insurers 10,11 . Although this phenomenon has been investigated among Medicare patients, 11 this issue has not been addressed in publicly insured YA to our knowledge 3 .…”

Section: Discussionsupporting

confidence: 67%

“…These findings echo the well-documented shift in US cancer care from office practices to hospitalaffiliated outpatient centers and accompanying discussion regarding higher expenditures at these sites, especially among commercial insurers. 10,11 Although this phenomenon has been investigated among Medicare patients, 11 this issue has not been addressed in publicly insured YA to our knowledge. 3 A 2020 rule proposed by the Centers for Medicare and Medicaid Services aimed at reducing differences in reimbursement according to outpatient setting, including the outpatient hospital scenario, highlights this discussion.…”

Section: Discussionmentioning

confidence: 99%

“…We examined the contribution of the following to HPP and OOP: 1) adjusted monthly rates of visits (inpatient, outpatient), 2) length of inpatient stay (LOS), 3) key adverse events after ALL diagnosis (using ICD-9 codes), and 4) chemotherapy (Healthcare Common Procedure Coding System, J-codes) expenditures. Among older populations with cancer, expenditures differ between outpatient hospitals (hospital-affiliated outpatient centers) and office visits (private physician offices) 10,11 ; thus, these were examined separately.…”

Section: Discussionmentioning

confidence: 99%

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Expenditures among young adults with acute lymphoblastic leukemia by site of care

Wolfson

Bhatia

Ginsberg

et al. 2021

Cancer

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Background Individuals diagnosed with acute lymphoblastic leukemia (ALL) between the ages of 22 and 39 years experience worse outcomes than those diagnosed when they are 21 years old or younger. Treatment at National Cancer Institute–designated Comprehensive Cancer Centers (CCC) mitigates these disparities but may be associated with higher expenditures. Methods Using deidentified administrative claims data (OptumLabs Data Warehouse), the cancer‐related expenditures were examined among patients with ALL diagnosed between 2001 and 2014. Multivariable generalized linear model with log‐link modeled average monthly health‐plan–paid (HPP) expenditures and amount owed by the patient (out‐of‐pocket [OOP]). Cost ratios were used to calculate excess expenditures (CCC vs non‐CCC). Incidence rate ratios (IRRs) compared CCC and non‐CCC monthly visit rates. Models adjusted for sociodemographics, comorbidities, adverse events, and months enrolled. Results Clinical and sociodemographic characteristics were comparable between CCC (n = 160) and non‐CCC (n = 139) patients. Higher monthly outpatient expenditures in CCC patients ($15,792 vs $6404; P < .001) were driven by outpatient hospital HPP expenditures. Monthly visit rates and per visit expenditures for nonchemotherapy visits (IRR = 1.6; P = .001; CCC = $8247, non‐CCC = $1191) drove higher outpatient hospital expenditures among CCCs. Monthly OOP expenditures were higher at CCCs for outpatient care (P = .02). Inpatient HPP expenditures were significantly higher at CCCs ($25,918 vs $13,881; ꞵ = 0.9; P < .001) before accounting for adverse events but were no longer significant after adjusting for adverse events (ꞵ = 0.4; P = .1). Hospitalizations and length of stay were comparable. Conclusions Young adults with ALL at CCCs have higher expenditures, likely reflecting differences in facility structure, billing practices, and comprehensive patient care. It would be reasonable to consider CCCs comparable to the oncology care model and incentivize the framework to achieve superior outcomes and long‐term cost savings. Lay Summary Health care expenditures in young adults (aged 22‐39 years) with acute lymphoblastic leukemia (ALL) are higher among patients at National Cancer Institute‐designated Comprehensive Cancer Centers (CCC) than those at non‐CCCs. The CCC/non‐CCC differences are significant among outpatient expenditures, which are driven by higher rates of outpatient hospital visits and outpatient hospital expenditures per visit at CCCs. Higher expenditures and visit rates of outpatient hospital visits among CCCs may also reflect how facility structure and billing patterns influence spending or comprehensive care. Young adults at CCCs face higher inpatient HPP expenditures; these are driven by serious adverse events.

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Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Expenditures among young adults with acute lymphoblastic leukemia by site of care

Wolfson

Bhatia

Ginsberg

et al. 2021

Cancer

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“…With the matched sample, we estimated spending using generalized linear models (GLMs) with log link and gamma distribution. 20 For outcomes of any hospitalization and ED visit, we fit logistic regression models, while for other utilization measures (counts), we estimated negative binomial models. We included the same set of covariates in the regression analysis as matching.…”

Section: Statistical Approachmentioning

confidence: 99%

Impact of Hospice on Spending and Utilization Among Patients With Lung Cancer in Medicare

Kalidindi

Segel

Jung

2019

Am J Hosp Palliat Care

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Objectives: To compare patterns and understand drivers of spending and utilization by month in the last 6 months of life between patients with lung cancer who used hospice versus those who did not. Study Design: Retrospective cohort analysis using 2009 to 2013 Medicare claims. Methods: We used a 10% random sample of Medicare fee-for-service beneficiaries with lung cancer who died between 2010 and 2013 (43 789 beneficiaries). Patients were assigned to 2 groups depending on whether they used hospice care in the last 6 months of life. The following outcomes were constructed by month: (1) all-cause Medicare spending, (2) indicator of hospitalization, (3) indicator of emergency department (ED) visit, (4) number of part B chemotherapy claims, and (5) number of radiation therapy sessions. We used a combination of propensity score matching and regression analysis to compare outcomes between the 2 groups. Results: Patients who used hospice had significantly lower spending in the last month of life compared to nonusers (US$16 907 vs US$26 906, P < .00). The spending differences in the last month of life between the 2 groups were largely driven by lower likelihood of hospitalization (54% vs 80%, P < .01) and ED visits (15% vs 22%, P < .01) and fewer chemotherapy (0.12 vs 0.32, P < .01) and radiation therapy sessions (0.80 vs 1.26, P < .01). During the other months in the 6-month period, spending was similar between the 2 groups. Conclusions: Timely hospice enrollment of patients with lung cancer—the group suffering from high morbidity and mortality among patients with cancer—may lead to significant cost savings.

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“…Several analyses have sited a large cost differential between chemotherapy administered in community-and hospital-based outpatient clinics. [6][7][8] Given this shift in site-of-care provision, we evaluated the cost differences of cancer care provided to patients with breast, lung, or colorectal cancer treated in a community-based or a hospital-based outpatient clinic to better elucidate the potential financial implications of this trend. A matched-cohort approach was used to control for potential confounding factors while costs were compared for clinically and demographically similar patients treated with the same chemotherapy regimens.…”

Section: Introductionmentioning

confidence: 99%

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

Gordan

Blazer

Saundankar

et al. 2018

JOP

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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.

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Differences in Health Care Use and Costs Among Patients With Cancer Receiving Intravenous Chemotherapy in Physician Offices Versus in Hospital Outpatient Settings

Abstract: Despite similar resource use, all-cause and cancer-related health care costs in HOP were significantly higher compared with those in PO settings.

Cited by 25 publications

References 11 publications

Expenditures among young adults with acute lymphoblastic leukemia by site of care

Expenditures among young adults with acute lymphoblastic leukemia by site of care

Impact of Hospice on Spending and Utilization Among Patients With Lung Cancer in Medicare

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

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