The use of optimal evidence-based chemotherapy (chemo) regimens in physician offices versus hospital outpatient facilities.

Abstract

6514 Background: The proportion of infused chemo administered in hospital outpatient facilities (HOF) increased from 6% in 2004 to 43% in 2014. The average annual cost for patients receiving chemo was significantly higher in HOFs than in physician offices (POs). One option to explore differences in the quality of care between these two settings is to examine the use of chemo regimens, which, based on their efficacy, toxicity, and costs, have been designated as “on-pathway.” This study compared on-pathway rates among patients receiving infused chemo administered in POs vs. those in HOFs. Methods: Using administrative claims data, we identified 61,496 breast, lung, or colorectal cancer patients receiving chemo from 2013 to 2018. Chemo regimens were considered “on-pathway” when they were on payer's program list of optimal regimens when administered. Generalized linear models examined the association between site of service and on-pathway prescribing rates, and costs of care. Models adjusted for age, sex, year, rural status, cancer type and setting, and comorbidities, with fixed effects for providers. Results: Percentage of infused chemo administered in HOFs increased from 44.2% in 2013 to 54.7% in 2018. After adjustment, on-pathway prescribing rate did not differ significantly between HOFs and POs (50.1%, 95% CI: 48.6%-51.5% vs. 49.8%, 95%CI: 48.3%-51.3%, p = 0.65). 6-month chemo cost ($56,885, 95% CI: $54,364-$59,524 vs $32,240, 95% CI: $30,929-$33,605, p < 0.001) and 6-month medical cost ($114,280, 95% CI: $110,716-$117,960 vs $79,455, 95% CI: $77,089-$81,893, p < 0.001) were significantly higher in HOFs vs. POs. Conclusions: Quality of care as measured by use of optimal chemo regimens was similar in hospital and office setting. Cost continues to be significantly higher in hospital setting. These findings provide a strong basis for site-neutral reimbursement policies.