Cost Of Cancer Care Research Articles

Deficient state-supported cancer care: A source of deep concern

Deficient state-supported cancer care: A source of deep concern

Direct Medical Cost of Breast Cancer Care in Lome: Case of Sylvanus Olympio University Hospital and International Cancer Centre

Direct Medical Cost of Breast Cancer Care in Lome: Case of Sylvanus Olympio University Hospital and International Cancer Centre

Abstract A052: Lifetime cost of care associated with squamous cell carcinoma of the anus in Puerto Rico

Abstract Background: Squamous cell carcinoma of the anus (SCCA), caused by human papillomavirus infection (HPV), is the most frequently diagnosed form of anal cancer (85%-90%). SCCA incidence has increased dramatically among the general population in Puerto Rico (nearly 5% annually) and the risk is disproportionately elevated among patients living with HIV. SCCA is preventable through HPV vaccination and screening. Therefore, the study of the cost of anal cancer care could have significant implications for understanding preventable economic burden in Puerto Rico. Objective: Determine the lifetime and phase-specific cost of SCCA cases aged ≥21 diagnosed during 2009-2016 in Puerto Rico. Method: This population-based study used the Puerto Rico Central Cancer Registry-Health Insurance Linkage Database (PRCCR-HILD), which links PRCCR data with health insurance claim data from the principal health insurance companies and the government health plan. PRCCR-HILD has information for almost 90% of Puerto Rico's cancer cases from 2008. We matched SCCA cases and non-cancer control (1:1) by age and sex for each phase of care (initial, continuation, and terminal). SCCA-related costs were calculated by subtracting the costs between SCCA patients and the control group. We used the phase-specific monthly cost estimates combined with survival data, stratified by age and cancer stage (localized, regional, and distance), to calculate the lifetime and average annual cost (discount at 3%) for SCCA. The cost was adjusted to 2019 US dollars using the consumer price index. We used the number of SCCA incident cases for 2019, stratified by age group and multiplied by the lifetime SCCA cost estimates, to calculate the SCCA-related lifetime economic burden for Puerto Rico. Results: Of the 351 patients with SCCA included in this study, the mean age at diagnosis was 64 years, 66.4% were women, 57.6% were diagnosed at a localized stage, and 23.1% were enrolled in private insurance. The overall survival after cancer diagnosis was 18 years. Meanwhile, the average monthly costs per patient were higher in the initial phase ($4,755), followed by the terminal phase ($3,499). The main cost driver in all phases was the outpatient costs. However, inpatient costs increased substantially at the terminal phase of care. The average lifetime cost for patient with SCCA was $137,343 (95% CI: $130,873-$145,241) (2019 US dollars). The average SCCA per year cost was $9,193 (95% CI: $8,744-$9,895), while the SCCA-related lifetime economic burden for 2018 in Puerto Rico was nearly $8.7 million. Conclusion: To our knowledge, this is the first study to describe the cost of SCCA management in Puerto Rico. Although SCCA continues to be relatively rare among the general population, our study shows that the SCCA-related lifetime economic burden is substantial and could continue to rise due to the rising SCCA burden in Puerto Rico. These findings could support the evaluation of the impact of strategies to reduce the SCCA burden through HPV vaccination and anal cancer screening for high-risk populations. Citation Format: Karen J. Ortiz-Ortiz, Axel Gierbolini-Bermúdez, Ana P. Ortiz, Karen Pabón-Cruz, Chi-Fang Wu, Jeslie Ramos-Cartagena, Reydi Morales-Martínez, Ashish A. Deshmukh. Lifetime cost of care associated with squamous cell carcinoma of the anus in Puerto Rico [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A052.

Financial Toxicity and Strain among Veteran and Civilian Men with Prostate Cancer

Purpose: The goal of this study was to examine financial toxicity and strain among Veterans and civilians in two different healthcare facilities. This study was based for the concerns for the rising cost of cancer care which can lead to societal financial toxicity. Societal financial toxicity is discussed at many levels of healthcare policy.

A Qualitative Study of Medical Oncologists’ Knowledge and Views of Biosimilars in the United States

Background: As the cost of cancer care continues to rise, biosimilars provide an important cost-saving treatment option. Thus, understanding barriers to biosimilar uptake, including perceptions of biosimilars among oncologists, is critical. We interviewed medical oncologists to examine their knowledge, attitudes, and perceptions of biosimilars. Methods: A snowball method was used to identify and recruit oncologists in 2019-2020. Following informed consent, a trained study interviewer conducted the semi-structured telephone interview covering the following topics: 1) knowledge of biosimilars; 2) views of the efficacy of biosimilars; and 3) perceptions of the future of biosimilars in oncology, including barriers to their use. Results: Interviews were conducted with oncologists (n=8) from four academic cancer centers. Median years of experience treating cancer patients was 7.5 (range = 4.5 to 10 years) and median number of cancer patients treated with biosimilars each month was 1 (range = 0 to 60 patients). Knowledge of biosimilars varied, although oncologists tended to lack knowledge of how biosimilar efficacy is established and expressed concerns about the lack of long-term data to support efficacy. Although these oncologists believed that biosimilars will become widely used, they noted that the lack of both long-term efficacy data and biosimilar knowledge are barriers to adoption. Conclusions: This study provides evidence for the need for biosimilar education for oncologists, particularly around biosimilar efficacy. Oncologists were cautiously optimistic that biosimilar use would lead to a reduction in healthcare costs. These findings will inform a national survey of oncologists’ knowledge and views of biosimilars.

EE442 Care Costs of Non-Small Cell Lung Cancer, Colorectal Cancer, and Thyroid Cancer in Turkiye: A Delphi Panel Study

Cancer is a global public health problem due to its increasing incidence and the high cost of care. This study aims to calculate the annual treatment costs for non-small cell lung cancer (NSCLC), colorectal cancer (CC), and follicular and papillary thyroid cancer (FPTC) in Turkiye.

Treatment Sequencing Patterns and Associated Direct Medical Costs of Metastatic Breast Cancer Care in the United States, 2011 to 2021

Advances in treatment of metastatic breast cancer (MBC) led to changes in clinical practice and treatment costs in the US over the past decade. There is limited information on current MBC treatment sequences and associated costs by MBC subtype in the US. To identify treatment patterns by MBC subtype and associated anticancer and supportive drug costs from health care sector and Medicare perspectives. This economic evaluation analyzed data of patients with MBC obtained from the nationwide Flatiron Health database, an electronic health record-derived, deidentified database with data from community and academic practices across the US from 2011 to 2021. Participants included women aged at least 18 years diagnosed with MBC, who had at least 6 months of follow-up data, known hormone receptor (HR) and human epidermal growth factor receptor 2 (ERBB2) receptor status, and at least 1 documented line of therapy. Patients with documented receipt of clinical study drugs were excluded. Data were analyzed from June 2021 to May 2022. Outcomes of interest were frequency of different drug regimens received as a line of therapy by subtype for the first 5 lines and mean medical costs of documented anticancer treatment and supportive care drugs per patient by MBC subtype and years since metastatic diagnosis, indexed to 2021 US dollars. Among 15 215 patients (10 171 patients [66.85%] with HR-positive and ERBB2-negative MBC; 2785 patients [18.30%] with HR-positive and ERBB2-positive MBC; 802 patients [5.27%] with HR-negative and ERBB2-positive MBC; 1457 patients [9.58%] with triple-negative breast cancer [TNBC]) who met eligibility criteria, 1777 (11.68%) were African American, 363 (2.39%) were Asian, and 9800 (64.41%) were White; the median (range) age was 64 (21-84) years. The mean total per-patient treatment and supportive care drug cost using publicly available Medicare prices was $334 812 for patients with HR-positive and ERBB2-positive MBC, $284 609 for patients with HR-negative and ERBB2-positive MBC, $104 774 for patients with HR-positive and ERBB2-negative MBC, and $54 355 for patients with TNBC. From 2011 to 2019 (most recent complete year 1 data are for patients diagnosed in 2019), annual costs in year 1 increased from $12 986 to $80 563 for ERBB2-negative and HR-positive MBC, $99 997 to $156 712 for ERBB2-positive and HR-positive MBC, and $31 397 to $53 775 for TNBC. This economic evaluation found that drug costs related to MBC treatment increased between 2011 and 2021 and differed by tumor subtype. These findings suggest the growing financial burden of MBC treatment in the US and highlights the importance of performing more accurate cost-effectiveness analysis of novel adjuvant therapies that aim to reduce metastatic recurrence rates for early-stage breast cancer.

The ripple effect: Cancer-related financial toxicity for family members and caregivers.

Globally, the rising costs of cancer care have resulted in "financial toxicity" borne by patients. Financial toxicity includes the direct costs of care, the psychological distress associated with financing care, and harmful coping mechanisms such as omitting medications and treatment due to cost. In this piece, we draw attention to a manifestation of financial toxicity that is often underrecognized and "undertreated," that is, how financial toxicity affects patients' families and primary caregivers. We focus on the context of Southeast Asia, a diverse region of over 650 million people, where there exist common cultural threads in the importance placed on family and filial piety, including in the setting of disease and healthcare-related decision making. We describe how the psychosocial and financial burden of cancer is often shared to a great extent by family members in a region where cancer is often seen as a disease of the whole family. The ripple effects of financial toxicity associated with cancer should broaden providers' purview when treating patients; however, the same ripple effects imply that efforts to mitigate financial toxicity for patients with cancer may greatly benefit their families and caregivers as well. We therefore argue that future work in research, clinical care, and health policy must take a multi-pronged approach to mitigating family financial toxicity, and we suggest steps forward. While we draw attention to family financial toxicity in Southeast Asia, it is important to recognize that financial toxicity of cancer is a global concern and occurs in regions of the world with greater financial resources. Further research is needed to elucidate the complexities of financial toxicity in the context of regional cultures, socioeconomic milieus, and cancer care systems. Critically, work is needed to develop, evaluate, and implement policies and interventions that are responsive to the needs of the most vulnerable. This article is protected by copyright. All rights reserved.

Assessing the cost and economic impact of tertiary-level pediatric cancer care in Tanzania.

Worldwide, an estimated 400,000 children develop cancer each year. The bulk of the mortalities from these cases occur in low-and-middle-income countries (LMICs). In Sub-Saharan Africa, there is a tremendous need to strengthen the capacity of health systems to provide high-quality cancer care for children. However, a lack of data on the economic impact of cancer treatment in low-resource settings hinders its consideration as a healthcare priority. To address this gap, this study models the clinical and financial impact of pediatric cancer care in Tanzania, a lower-middle income country in East Africa. We conducted a retrospective review of patients with cancer under the age of 19 years treated at Bugando Medical Centre from January 2010 to August 2014. Information was collected from a total of 161 children, including demographics, type of cancer, care received, and five-year survival outcomes. This data was used to calculate the number of averted disability-adjusted life-years (DALYs) with treatment. Charges for all direct medical costs, fixed provider costs, and variable provider costs were used to calculate total cost of care. The societal economic impact of cancer treatment was modeled using the value of statistical life (VSL) and human capital methods. The total health impact for these 161 children was 819 averted DALYs at a total cost of $846,743. The median cost per patient was $5,064 ($4,746-5,501 interquartile range). The societal economic impact of cancer treatment ranged from $590,534 to $3,647,158 using VSL method and $1,776,296 using a human capital approach. Despite the limitations of existing treatment capacity, economic modeling demonstrates a positive economic impact from providing pediatric cancer care in Tanzania. As many countries like Tanzania progress towards achieving Universal Health Coverage, these key economic indicators may encourage future investment in comprehensive pediatric cancer care programs in low-resource settings to achieve clinically and economically beneficial results not only for the individual patients, but for the country as a whole.

Total Cost of Cancer Care: Evaluating Health System Expenditures through Eight Performance Periods of the Oncology Care Model

<h3>Purpose/Objective(s)</h3> The Oncology Care Model (OCM) is an alternative payment model aimed at providing higher quality, lower cost care to participating Medicare beneficiaries. However, information regarding trends in spending, particularly for radiation oncology (RO) services, is limited. <h3>Materials/Methods</h3> We identified 17,157 episodes of care from 9,898 patients treated at a statewide multispecialty health system through the first eight six-month Performance Periods (PP1-8; July 1, 2016 to June 30, 2020) of the OCM. Aggregate spending stratified by 10 expenditure domains (e.g., Part B/D drugs, RO, etc.) and 21 disease sites was extracted from claims data. A subset analysis of RO expenditures was performed on 2,149 episodes from 2,033 patients treated with radiotherapy (RT). All expenses are expressed in per beneficiary, per episode (PBPE) terms indexed to average PBPE. <h3>Results</h3> Indexed to the average PBPE payment, average expenditures increased (P_trend < 0.001) from 92% in PP1 to a peak of 111% in PP7. Part B and D drugs were used in 87% and 23% of episodes, whereas RO services were used in 13%. Part B spending increased from 41.9% of PBPE expenses in PP1 to 45.6% in PP8 and Part D spending increased from 17.0% to 22.6%, whereas RO spending decreased from 2.6% to 2.4%. Physician services and in-hospital costs also decreased from 11.2% and 11.4% to 8.4% and 8.3%, respectively. By disease site, the largest PBPE expenses were for melanoma (234%), multiple myeloma (226%), and kidney cancer (191%), for which Part B/D spending accounted for 77%, 82%, and 81% of spending for each site, respectively. Among sites with the highest total expenditures, increases in Part B/D spending from PP1-8 were seen for breast (+11%), multiple myeloma (+11%), lung (+12%), and prostate (+7%), and chronic leukemia (+12%). Among sites with the highest RO spending, decreases in RO expenses were seen for breast (-1%), lung (-1%), and female genitourinary (-4%), while an increase was seen for prostate (+4%). On subset analysis, the average number of RT fractions per episode decreased from 19.2 in PP1 to 18.6 in PP8; this decrease was seen for breast (-2.1) and lung (-2.8) cancers but not for prostate (unchanged). Intensity-modulated RT charges accounted for 51% of RT spending and increased 5% from PP1-8, whereas 3D/electron external beam made up 21% and decreased 8%. Expenses for image guidance (17%; +2%), stereotactic RT (9%; +1%), radiopharmaceuticals (1.4%; +0.5%), and brachytherapy (1.4%; +0.5%) all increased. <h3>Conclusion</h3> The total cost of oncology care continues to rise, driven by increases in Part B and Part D drug spending. Conversely, RO expenditures were small and decreased on a relative basis over the study period. Future payment models directed at meaningfully managing the total cost of cancer care will need to prioritize high cost and high growth areas of spending, including novel drug therapies, while accounting for patient outcomes.

Multiscale analysis of cancer service areas in the United States

The purpose of delineating Cancer Service Areas (CSAs) is to define a reliable unit of analysis, more meaningful than geopolitical units such as states and counties, for examining geographic variations of the cancer care markets using geographic information systems (GIS). This study aims to provide a multiscale analysis of the U.S. cancer care markets based on the 2014–2015 Medicare claims of cancer-directed surgery, chemotherapy, and radiation. The CSAs are delineated by a scale-flexible network community detection algorithm automated in GIS so that the patient flows are maximized within CSAs and minimized between them. The multiscale CSAs include those comparable in size to those 4 census regions, 9 divisions, 50 states, and also 39 global optimal CSAs that generates the highest modularity value. The CSAs are more effective in capturing the U.S. cancer care markets because of its higher localization index, lower cross-border utilizations, and shorter travel time. The first two comparisons reveal that only a few regions or divisions are representative of the underlying cancer care markets. The last two comparisons find that among the 39 CSAs, 54% CSAs comprise multiple states anchored by cities near inner state borders, 28% are single-state CSAs, and 18% are sub-state CSAs. Their (in)consistencies across state borders or within each state shed new light on where the intervention of cancer care delivery or the adjustment of cancer care costs are needed to meet the challenges in the U.S. cancer care system. The findings could guide stakeholders to target public health policies for more effective coordination of cancer care in improving outcomes and reducing unnecessary costs.

Discussion of costs and financial burden in clinical practice: A survey of medical oncologists in Australia.

BackgroundA diagnosis of cancer is associated with significant physical, psychological and financial burden. Including costs of cancer is an important component of shared decision making. Doctors bear a responsibility towards educating patients about the financial aspects of care. Multiple organisations have advocated for price transparency and implementing Informed Financial Consent in the clinic. However, few studies have evaluated the perspectives of oncologists on the current state of this discussion.AimsThe aim of this study is to determine the views and perspectives of medical oncologists regarding communication of costs and financial burden in patients with cancer.MethodsWe conducted a prospective cross-sectional online survey via REDCap. The survey was distributed to medical oncologists and advanced trainees currently registered with Medical Oncology Group of Australia (MOGA). Data was collected using the online survey comprising socio-demographic characteristics, discussion of costs and financial burden, and facilitators and barriers to these discussions.Results547 members of MOGA were invited to participate in the study, and 106 of 547 MOGA members (19%) completed the survey. Most oncologists (66%) felt that it was their responsibility to discuss costs of care, however a majority of oncologists (59.3%) reported discussing costs with less than half of their patients. Only 25% of oncologists discussed financial concerns with more than half of their patients, and most oncologists were unfamiliar with cancer-related financial burden. Most Oncologists with greater clinical experience and those working in private practice were more likely to discuss costs with a majority of their patients.ConclusionsCertain characteristics of medical oncologists and their practices were associated with reported prevalence of discussing costs of care and financial burden with their patients. In the context of rising costs of cancer care, interventions targeting modifiable factors such as raising oncologist awareness of costs of care and financial burden, screening for financial toxicity and availability of costs information in an easily accessible manner, may help increase the frequency of patient-doctor discussions about costs of care, contributing to informed decision-making and higher-quality cancer care.

Addressing Barriers to Colorectal Cancer Screening by Implementing a Colorectal Cancer Screening Program on a Mobile Health Unit

INTRODUCTION: Several barriers to healthcare access contribute to disparity in colorectal cancer screening. We developed a program to address structural and financial barriers to colorectal cancer screening in our community using an established mobile health unit. METHODS: This mobile health team aims to improve health and prevent chronic disease by providing wellness education and taking physiological measurements such as glucose and blood pressure. In partnership with this unit, we began providing fecal immunochemical test (FIT) tests to English- and Spanish-speaking patients aged 45 years and older during their visits to the mobile unit for other health examinations. Participants complete the FIT at home and return it via postal mail. A patient navigator follows up with participants. If the FIT is positive, the participant undergoes a colonoscopy. If the participant is uninsured, cost of colonoscopy and/or cancer care are covered by our institution. Participants complete surveys at baseline, test completion, and upon receiving their results. RESULTS: We have enrolled 34 participants, 65% women, median age: 55 years (interquartile range = 12). The majority (90%) of patients did not have health insurance, and 76% were Spanish-speaking. Most (88%) knew they were due for colorectal cancer screening, but 85% had never been screened for various reasons (Table). To date, 71% of participants have completed FIT testing, and 100% of completion survey respondents plan to repeat FIT testing next year. CONCLUSION: Our preliminary results demonstrate the feasibility of addressing structural and financial barriers to colorectal cancer screening by initiating FIT testing programs on existing mobile community health units. Table. - Enrollee-Reported Primary Past Barriers to Colorectal Cancer Screening Barrier Percentage I’ve never had the opportunity 26% I don’t have insurance 19% I didn’t think it was necessary 14% Testing is too expensive 11% I don’t know 11% Other 19%

Navigating the Continuum of Care: Common Goods and Uncommon Experiences

In light of his experience as clinical bioethicist in a healthcare institution in the U.S.A. (i.e., Anne Arundel Medical Center in Annapolis, MD), Christian Cintron reflects on concrete challenges–from the COVID-19 pandemic to the increasing costs of cancer care for individuals and families–that test the ability of providing care to cancer patients. Hence, policy reforms are urgent. They should aim at transforming practices in prevention and in providing care, while avoiding what he calls “financial toxicity.” The stories of three patients exemplify both the ethical concerns and the needed structural solutions to foster prevention. The equitable participation of cancer patients through solidaristic practices exemplifies one approach leading to systemic improvements.

Do clinical pathways impede provider workflow: A provider efficiency analysis of time spent using an EHR-embedded clinical decision support tool.

381 Background: With the growing complexity and cost of cancer care, adoption of oncology pathway tools as clinical decision support (CDS) has increased at the point of care. These tools have been shown to improve care quality, reduce variations in care and reduce healthcare costs. Flatiron Assist (FA) is a customizable CDS tool that is embedded in the electronic health record (EHR) to facilitate selection and documentation of National Comprehensive Cancer Network (NCCN) guideline concordant cancer treatment regimens. The time burden of engaging with CDS tools is a top concern for clinicians and often limits uptake of these tools. However, data on the actual time spent utilizing these tools in clinical practice is limited. Our study reports on the time spent by clinicians in various oncology practices, utilizing and ordering cancer treatment regimens with a CDS tool. Methods: We reviewed all completed sessions in FA from July 23, 2021 to May 23, 2022 by 878 prescribers at 24 academic and community oncology centers. Sessions that were part of an electronic prior authorization pilot program were excluded for purposes of standardization. Session length was defined as the time from the completion of application launch to application exit. For prescribers who completed over 20 sessions, we compared the mean sessions lengths of user’s initial sessions (#1-10) to subsequent sessions (#11-20) using paired t tests. We also determined the total number of potential CDS tool sessions per user per week. Results: All 14,394 CDS tool sessions were analyzed during the 10 month observation period. Median session length was 42 seconds (95th percentile, 253 seconds or 4.2 minutes). The average number of treatment orders placed was 5 per week per provider. Table shows the median session length across the 9 most commonly treated cancers. For the 31 prescribers who started using FA during the study and completed more than 20 sessions, the mean (SD) session length decreased from 95.2 (11.8) seconds in sessions #1-10 to 71.0 (6.0) seconds in sessions #11-20 (two-sided P = 0.034). Conclusions: Utilization of FA as a CDS tool to provide guideline concordant care is feasible and adds less than 4 minutes/week on average to a provider’s workflow. When used effectively, it can integrate seamlessly into provider workflows across academic and community practices without disruptive increases in time or effort of cancer treatment regimen ordering. Future studies are needed to evaluate the impact of product improvements, content changes, and electronic prior authorization integrations on time in this workflow.[Table: see text]

Association between oncology clinical pathway utilization and quality and cost outcomes in patients with metastatic solid tumors.

430 Background: Anticancer drug regimens that are approved by accepted drug compendia and also considered high value based on their efficacy, toxicity, and costs are designated as “on-pathway” for a national commercial payer. This study compared quality and cost of cancer care among patients with metastatic solid tumors treated in the first line setting who were prescribed on- vs. off-pathway regimens. Methods: Using administrative claims data and prior authorization data from a national commercial payer, we identified 8,357 commercially insured or Medicare Advantage adult patients with solid tumor cancers including breast, lung, colorectal, pancreatic, melanoma, kidney, bladder, gastric, or uterine cancer, who were prescribed first-line anti-cancer regimens in the metastatic setting from 2018 to 2021. Patients were classified into on- vs. off pathway group based on the initial anticancer regimen that was prescribed. On-pathway status was prospectively defined by a panel of practicing oncologists based on review of curated evidence and general application of relative clinical value frameworks accepted in the field. We compared post–6-month quality-of-care outcomes including chemotherapy-related avoidable hospitalizations, emergency room (ER) visits, immune-related adverse events (IRAEs) such as endocrinopathies owing to immune checkpoint inhibitors, need for supportive drugs such as granulocyte colony stimulating factor, and cost outcomes between groups. Generalized linear models were used to assess the association between on-pathway regimens and outcomes adjusting for key patient demographics, clinical and provider characteristics. Results: A total of 5,453 (65.3%) patients were prescribed on-pathway regimens. Both groups had similar age (60.1 vs. 59.6, p = 0.06) and ECOG performance status (0.63 vs. 0.62, p = 0.40), with more females in the off-pathway group (54.6% vs. 57.3%, p = 0.02). There was no statistically significant difference in chemotherapy-related avoidable hospitalizations, IRAEs and need for supportive drugs between the two groups after modeling adjustment. However, patients treated on-pathway had higher rates of chemotherapy-related avoidable ER visits (18% vs. 15%, adjusted odds ratio: 1.16, 95% confidence interval (CI): 1.01 to 1.33, p = 0.03). Patients in the on-pathway group had significantly lower 6-month anticancer treatment cost (adjusted cost difference: -$10410, 95% CI: -$14935 to -$5886, p &lt; 0.01), resulting in an overall lower total healthcare costs (adjusted cost difference: -$12826, 95% CI: -$18879 to -$6773, p &lt; 0.01). Conclusions: Pathway regimens for metastatic solid tumors were associated with reduced total healthcare costs and similar quality of care compared with off-pathway regimens. These findings support the use of high value, evidence-based regimens for metastatic cancer patients.

Impact of proposed 2022 changes to the Merit-Based Incentive Payment System (MIPS) on oncologist performance and reimbursement.

6 Background: In 2017, the Centers for Medicare &amp; Medicaid Services (CMS) executed a landmark bipartisan legislation aimed at gradually shifting American healthcare from a fee-for-service model to a value-based system. The resulting payment model, MIPS, uses cost and quality metrics to assign clinicians an overall MIPS score, where higher scores correspond to greater payments for practices. In 2018, cost metrics contributed only 10% of this composite score, while quality metrics contributed 50%. Beginning with 2022, the cost and quality categories will be equally weighted (30% each) to encourage clinicians to reduce healthcare costs. As the cost of cancer care is disproportionately high, we investigated the implications of the updated scoring on reimbursements for oncologists and other providers participating in MIPS. Methods: We included physicians participating in the 2018 MIPS Performance Year files. We categorized hematological-, medical, radiation, gynecological, and surgical oncologists as oncologists and delineated those with National Cancer Institute-designated Cancer Center (NCICC)-affiliation. We excluded individuals who were exempt from reporting cost scores due to their MIPS-filing method. We calculated the projected 2022 MIPS composite scores (range, 0-100) by multiplying the 2022 weights by the 2018 component scores. We compared the change in composite MIPS score and the corresponding negative payment adjustments due to reweighing across specialties. Clopper–Pearson 95% confidence intervals were reported. Results: The cohort included 168,659 physicians, of which 163,150 (97%) were non-oncologists and 5,509 (3%) were oncologists. Of oncologists, 1,757 (32%) were at a NCICC. Cost scores (higher is better) for each group were as follows: non-oncologists, 75.2; all oncologists, 65.5; NCICC oncologists, 57.1. Reweighing the 2018 MIPS composite scores with the updated 2022 cost/quality weights resulted in a mean 1.7-point decrease (88.7 to 87) for non-oncologists, a 3.8-point decrease (89.7 to 85.9) for all oncologists, and a 5.2-point decrease (89.2 to 84) for NCICC oncologists. Following the reweighing, the proportion of non-oncologists incurring penalties will increase by 12.8% (95% CI, 12.7%–12.9%); all oncologists by 14.3% (95% CI, 13.2%–15.4%); and NCICC oncologists by 20% (95% CI, 18.1%–21.9%). Conclusions: Beginning with 2022 performance year, federally mandated reweighing of MIPS cost metrics will result in a disproportionate increase in oncologists receiving negative payment adjustments. With a majority Medicare population with new cancer diagnoses, higher patient complexity, and declining operating margins at many oncologic practices, we highlight striking upcoming changes that may inform further optimization of MIPS cost metrics by CMS to ensure oncologists providing high quality care are not penalized.

Cancer-related costs should be allocated in a comparable way—benchmarking costs of cancer in Nordic countries 2012–2017

Background High costs of cancer, and especially the increase in treatment costs, have raised concerns about the financial sustainability of publicly funded health care systems around the world. As cancers get more prevalent with age, treatment costs are expected to keep rising with aging populations. The objective of the study is to analyze the changes in cost of cancer care broken down into separate cost components and outcomes of cancer treatment in the Nordic countries 2012–2017. Materials and methods We estimated direct costs of cancer based on retrospective data from national registers: outpatient care and inpatient care in primary care and specialized care as well as medicine costs. The number of cancer cases and survival data was obtained from NORDCAN. Cancer was defined as ICD-10 codes C00–C97. Results Healthcare costs of cancer in real terms increased in all countries: CAGR was between 1 and 6% depending on the country. Medicine costs have increased rapidly (37–125%) in all countries during the observation period. In Finland and Denmark, inpatient care costs have decreased, whereas in Iceland, Norway, and Sweden, they have increased, although the number of inpatient days has decreased everywhere. The age-standardized cancer mortality has decreased constantly over time. Conclusion Cancer care in Nordic countries has significant differences in both cost structures and in the development of cost drivers, indicating differences in the organization of care and different focus in health policy. It is important to compare the cancer care costs internationally on a detailed level to understand the reasons for cost development. The registration of cost data, especially medicine costs, should be more standardized to enable better cost and outcomes comparisons between countries in the future.

Bayesian Network Analysis for Prediction of Unplanned Hospital Readmissions of Cancer Patients with Breakthrough Cancer Pain and Complex Care Needs.

Background: Unplanned hospital readmissions (HRAs) are very common in cancer patients. These events can potentially impair the patients’ health-related quality of life and increase cancer care costs. In this study, data-driven prediction models were developed for identifying patients at a higher risk for HRA. Methods: A large dataset on cancer pain and additional data from clinical registries were used for conducting a Bayesian network analysis. A cohort of gastrointestinal cancer patients was selected. Logical and clinical relationships were a priori established to define and associate the considered variables including cancer type, body mass index (BMI), bone metastasis, serum albumin, nutritional support, breakthrough cancer pain (BTcP), and radiotherapy. Results: The best model (Bayesian Information Criterion) demonstrated that, in the investigated setting, unplanned HRAs are directly related to nutritional support (p = 0.05) and radiotherapy. On the contrary, BTcP did not significantly affect HRAs. Nevertheless, the correlation between variables showed that when BMI ≥ 25 kg/m2, the spontaneous BTcP is more predictive for HRAs. Conclusions: Whilst not without limitations, a Bayesian model, combined with a careful selection of clinical variables, can represent a valid strategy for predicting unexpected HRA events in cancer patients. These findings could be useful for calibrating care interventions and implementing processes of resource allocation.

Cancer cost profiles: The Epicost estimation approach.

Sustainability of cancer burden is becoming increasingly central in the policy makers' debate, and poses a challenge for the welfare systems, due to trends towards greater intensity of healthcare service use, which imply increasing costs of cancer care. Measuring and projecting the economic burden associated with cancer and identifying effective policies for minimising its impact are important issues for healthcare systems. Scope of this paper is to illustrate a novel comprehensive approach (called Epicost) to the estimation of the economic burden of cancer, based on micro-data collected from multiple data sources. It consists of a model of cost analysis to estimate the amount of reimbursement payed by the National Health Service to health service providers (hospitals, ambulatories, pharmacies) for the expenses incurred in the diagnoses and treatments of a cohort of cancer patients; these cancer costs are estimated in various phases of the disease reflecting patients' patterns of care: initial, monitoring and final phase. The main methodological features are illustrated using a cohort of colon cancer cases from a Cancer Registry in Italy. This approach has been successfully implemented in Italy and it has been adapted to other European countries, such as Belgium, Norway and Poland in the framework of the Innovative Partnership for Action Against Cancer (iPAAC) Joint Action, sponsored by the European Commission. It is replicable in countries/regions where population-based cancer registry data is available and linkable at individual level with administrative data on costs of care.