Impact and value of olanzapine as part of a 4-drug regimen in patients receiving high emetic risk chemotherapy.

Abstract

293 Background: The Michigan Oncology Quality Consortium, MOQC, has increased the use of olanzapine as part of a 4-drug antiemetic regimen for high emetic risk chemotherapy in many of its 50 practices across Michigan. The purpose of this project was to estimate the impact of olanzapine prescribing on health care utilization and subsequent savings in healthcare utilization payments in patients with breast cancer on (neo)adjuvant doxorubicin and cyclophosphamide (AC) for breast cancer. Methods: Multipayer claims data were used from the Michigan Value Collaborative (MVC), a collaborative quality initiative of over 100 hospitals and 40 physician organizations with the goal of improving healthcare value. We identified a cohort of female patients with a 90-day episode of care for breast cancer resection between 2016-2021 who received chemotherapy with AC as (neo)adjuvant chemotherapy. Patients were covered by Blue Cross Blue Shield of Michigan insurance plans or Medicare. Each patient was attributed to one practice using National Provider Identifiers on professional claims. Facility claims were used to identify inpatient admissions and emergency department (ED) visits across the patient’s course of chemotherapy, up to 21 days following final chemotherapy. Practice-level use of olanzapine abstracted by MOQC as part of ASCO’s Quality Oncology Practice Initiative (QOPI™) data collection was used to determine whether each patient's chemotherapy treatment began when the practice had “high” (≥25%) or “low” (<25%) rates of olanzapine use for high emetic risk chemotherapy. We compared healthcare utilization among patients treated by high- vs. low-prescriber practices and calculated the estimated differences in price-standardized payments attributed to olanzapine use. Results: We identified 1,891 total patients attributed to 45 MOQC practices; 922 patients were attributed to 15 practices that eventually became high prescribers. Patients treated by a high olanzapine prescribing practice had significantly lower hospitalization rates (10%) during chemotherapy compared to patients treated when their attributed practice was a low olanzapine prescriber (15%, p=0.02). There was no difference in the proportion of patients visiting the ED. The mean per-patient price-standardized insurance payment for inpatient hospitalization for this cohort was $12,007. Increased use of olanzapine led to an estimated payment savings of $334,095 in prevented hospitalizations among 525 patients treated when their attributed practice had a high olanzapine prescribing rate. Conclusions: In this patient sample, practice use of olanzapine in ≥ 25% of patients on high emetic risk chemotherapy was associated with significant reductions in the risk of hospitalization. As the proportion of patients receiving olanzapine increases, we expect even greater reductions in the risk of hospitalization and greater cost savings.