Intravenous Cancer Treatments Pricier in Hospital than in Community Office Setting

June 2014, Vol 5, No 5

Tampa, FL—Intravenous (IV) cancer therapies are more costly, by approximately 10%, when patients receive them in a hospital outpatient setting rather than in a community-based physician office, according to a study presented at the 2014 Academy of Managed Care Pharmacy meeting.

Barbara L. McAneny, MD, Chief Executive Officer and Managing Partner, New Mexico Cancer Center, Albuquerque, and one of the study investigators, said that the research adds to the growing evidence that care is more costly in the hospital setting. “As we switch to more high-deductible health plans, out-of-pocket costs per patient go up considerably, which makes cancer care increasingly difficult for patients to afford,” Dr McAneny told Value-Based Cancer Care. “The current trend of acquisition of practices by hospitals is exactly the wrong direction for the country to be going in at a time when healthcare costs are spiraling out of control.”

This retrospective analysis was based on pharmacy and medical claims from a database with approximately 32 million covered members in the United States. Adult patients were included if they received IV cancer treatment with a chemotherapy or a biologic agent between 2006 and August 31, 2012, and had ?2 medical claims, at least 30 days apart for a cancer, no secondary cancer, and at least 6 months of preindex and postindex health plan eligibility.

A total of 18,740 patients were assigned to a community physician office cohort or to a hospital outpatient cohort, depending on where they received at least 95% of their IV treatment. The 5 cancer types included early breast cancer (47.5%), metastatic breast cancer (22.1%), non-Hodgkin lymphoma/chronic lymphocytic leukemia (11.9%), metastatic lung cancer (10.1%), and colorectal cancer (8.4%).

During a 12-month period, the mean total healthcare costs were significantly higher for patients who received treatment in the outpatient setting than in the community setting—$122,473 versus $82,773.

Patients seen in the outpatient setting also had 415 days treatment duration versus 300 days in the office setting, higher 6-month treatment costs—$103,460 versus $68,792, respectively, and higher 12-month treatment costs of $143,206 versus $98,071 (all P <.001). After adjusting for baseline characteristics, the average annual costs for patients seen in community offices were 8% lower than for patients seen in a hospital outpatient setting.

According to Ted Okon, Executive Director, Community Oncology Alliance, Washington, DC, there is overwhelming evidence that cancer care costs taxpayers and patients more in hospital outpatient departments. “This is disconcerting, because hospitals are rapidly acquiring community cancer clinics. This flies in the face of healthcare reform designed to lower costs. If the consolidation of cancer care into hospitals continues, we will drive cancer care costs to unsustainable levels,” Mr Okon told Value-Based Cancer Care. “It took close to 50 years to evolve the world’s best cancer care delivery system to provide quality, affordable, accessible cancer care in communities across the country. In close to 5 years, we are dismantling that system. Every American should be alarmed at this.”

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