Abstract
ObjectivesTo investigate the impact of provider payment reforms and associated care delivery models on cost and quality in cancer care.MethodsData sources/study setting: Review of English-language literature published in PubMed, Embase and Cochrane library (2007–2019).Study design: We performed a systematic literature review (SLR) to identify the impact of cancer care reforms. Primary endpoints were resource use, cost, quality of care, and clinical outcomes.Data collection/extraction methods: For each study, we extracted and categorized comparative data on the impact of policy reforms. Given the heterogeneity in patients, interventions and outcome measures, we did a qualitative synthesis rather than a meta-analysis.ResultsOf the 26 included studies, seven evaluations were in fact qualified as quasi experimental designs in retrospect. Alternative payment models were significantly associated with reduction in resource use and cost in cancer care. Across the seventeen studies reporting data on the implicit payment reforms through care coordination, the adoption of clinical pathways was found effective in reduction of unnecessary use of low value services and associated costs. The estimates of all measures in ACO models varied considerably across participating providers, and our review found a rather mixed impact on cancer care outcomes.ConclusionThe findings suggest promising improvement in resource utilization and cost control after transition to prospective payment models, but, further primary research is needed to apply robust measures of performance and quality to better ensure that providers are delivering high-value care to their patients, while reducing the cost of care.
Highlights
Cancer care is moving toward more advanced, targeted treatments that have the potential to improve health outcomes
Alternative payment models were significantly associated with reduction in resource use and cost in cancer care
Across the seventeen studies reporting data on the implicit payment reforms through care coordination, the adoption of clinical pathways was found effective in reduction of unnecessary use of low value services and associated costs
Summary
Cancer care is moving toward more advanced, targeted treatments that have the potential to improve health outcomes. Available projections for cancer care cost in the United Kingdom, the United States (US), and Australia suggest a dramatic increase from 42% to 66% above their current levels by 2025 [1], [2],[3]. During the past five years, 68 high-cost, novel therapies were launched globally for the treatment of cancer [4], so the challenge is developing more compelling evidence on whether this expensive paradigm shift leads to better outcomes. Additional increases in cancer treatment costs are associated with the availability of these high-cost novel agents, as well as use of combination therapies and multiple lines of treatment [4]. Further efforts are required to ensure that providers apply efficient resource-utilization strategies without adversely affecting the quality of care
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