Overuse of five expensive oncology pharmaceuticals in the southeastern United States: A physician-level analysis.

Abstract

33 Background: The Wall Street Journal recently identified that the highest rates of use of erythropoietin to Medicare-covered persons with cancer in the United States was by 11 oncologists who practiced in Florida (WSJ, June 20, 2014). We asked a related, but similar question: Could chemotherapy claims databases be used to identify individual physicians in the southeastern United States who had high rates of prescribing five expensive oncology agents: levoleucovorin (Fusilev), palonosetron plus fosapretitant (Aloxi+Emend), peg-filgastrim (Neulasta), albumin-paclitaxel (Abraxane), and epoetin/darbepoetin? Methods: Chemotherapy requests for more than 2,000 oncologists who practiced in the southeastern United States for the years 2012- 2014 were reviewed. A “high user” oncology provider for a specific drug was operationally defined as an individual whose number of prescriptions for the specific drug was more than 2 standard deviations above that for other oncology providers whose chemotherapy requests were also contained in the same database. Results: Two out of 1,479 oncology providers were identified as “extremely high users” of expensive oncology drugs (operationally defined as a high user for 5 of the 5 study drugs), two were “very high users” of expensive oncology drugs (a high user for 4 of the 5 study drugs), and 25 were “high users” (a high user for three of the five study drugs). The overwhelming majority of oncology providers (1,450) were neither extremely high, very high, nor even high users of the five study drugs. Conclusions: In the Southeastern United States, a small number of oncology physicians are extremely high, very high, and high users of expensive oncology drugs. Additional studies are needed to evaluate case-mix and other patient-related factors that might explain this finding. Focused quality improvement initiatives might also be considered. [Table: see text]