Cost of care associated with utilization of telehealth in clinical trials.

Abstract

e13682 Background: Due to COVID-19 pandemic restrictions, telehealth was incorporated into standard oncologic care and clinical trials. Existing data show that telehealth in clinical trials is safe, feasible, and reduces barriers to participation. We sought to analyze whether telehealth changed the cost of care compared to traditional clinical trial operations. Methods: We conducted a retrospective cohort study of gynecologic oncology patients enrolled in therapeutic clinical trials at a NCCN designated cancer center, comparing health care reimbursement cost of care on trial pre-TELEhealth (9/30/2019 to 3/15/2020) with those during TELEhealth (3/16/2020 to 8/20/2020). Inclusion required trial enrollment during both study periods, at least 1 telehealth visit, and identifiable billing records. Health care costs were collected. Cost data included: 2020 Medicare reimbursements for procedures, provider billing, DRG for hospital admissions, drug average sales price, and GoodRx for outpatient prescriptions. Encounters unrelated to cancer care were excluded. Overall cost per patient and patient-per-month on trial were calculated for scheduled (per protocol) and unscheduled (non-protocol) encounters. Pairwise t-tests between pre-TELE and TELE periods were performed. Results: 28 patients were included (86% White, 7% Black, 6% other) with 26 (93%) ovarian, 1 (4%) uterine, and 1 (4%) concurrent ovarian/uterine cancer. The majority (89%) had stage 3 or 4 cancer at diagnosis. Overall care utilization was similar in pre-TELE and TELE periods, with 292 vs. 321 scheduled visits, and 31 vs. 37 unscheduled visits. Mean total cost per patient was similar in pre-TELE and TELE periods, including scheduled encounters ($15794.58 (SD 17719.92) vs. $20714.47 (SD 25338), p= 0.118) and unscheduled encounters ($759.96 (SD 2066.72) vs. $2911.71 (SD 6060.18), p=0.080). Per month on trial, mean cost per patient did not differ. No differences were seen in total scheduled or total unscheduled encounters, nor office visits, admissions, ED visits and outpatient procedures. Conclusions: Incorporation of telehealth in gynecologic cancer clinical trials did not increase cost of scheduled or unscheduled care. Telehealth is a critical component to decentralizing clinical trials, reducing barriers to trial participation and improving the value of cancer care. [Table: see text]