Abstract
e20717 Background: Place of care may be an important factor affecting treatment & economic outcomes for pts in advanced stages of cancer. This retrospective observational study compared treatment patterns, healthcare resource use & costs, and overall survival (OS) for pts treated for selected cancers in the hospital outpatient department (HO) vs community oncology practices (CP) including physician offices & freestanding ambulatory centers. Methods: Claims data from a large national health plan were used to identify adult pts with newly diagnosed advanced/metastatic non small cell lung cancer (aNSCLC), metastatic breast (mBC) or metastatic colorectal cancer (mCRC) between 07/2012 & 12/2016, who initiated anticancer therapy in HO or CP settings. Pts enrolled in Medicare Advantage Prescription Drug (MAPD) or commercial plans for ≥ 6 months prior & ≥ 30 days after start of first line (1L) (index date) were included. OS was evaluated among pts enrolled in MAPD and costs were evaluated among pts enrolled ≥ 6 months pre- & post-index, by cancer type & by place of care. Outcome analyses were adjusted using multivariable models. Results: Among 8,333 eligible pts, there were 4,618, 2,304 & 1,411 pts with aNSCLC, mCRC & mBC, respectively and each cohort was evenly split by place of care. No notable differences in baseline characteristics or the most commonly used 1L, 2L or 3L regimens were observed by place of care for the 3 cancers. For aNSCLC pts, mean 1L treatment duration was shorter (96 v 102 days, P = 0.02) and time between 1L & 2L was longer (125 v 106 days, P = 0.04) in the HO than the CP setting, respectively. For mBC, mean 1L treatment duration was longer in the HO setting (156 v 190 days, P < 0.01). Adjusted total all cause healthcare costs were higher in HO than CP for mBC ( P < 0.01) & mCRC ( P < 0.01), but no significant difference in median OS was observed between HO & CP settings for the 3 cancer types. Conclusions: This study showed no major differences between HO & CP settings in baseline characteristics, the first 3 lines of therapy, or adjusted median OS for aNSCLC, mCRC, or mBC cohorts. However, total costs were higher in the HO setting for mCRC & mBC pts. These findings may be useful for healthcare decision & policy makers but warrant further evaluation.
Published Version
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