The average cost of treating one patient with cancer may be more than $25,000 per 180-day treatment episode, with costs driven largely by antineoplastic agents and inpatient care, according to an article published in the Journal of Oncology Practice.1

With the cost of cancer care expected to exceed $170 billion in the United States by 2020, increasing pressure is falling on oncologists to help reduce cancer treatment–associated expenses. One method introduced by the Center for Medicare and Medicaid Services, the Oncology Care Model (OCM), is intended to improve treatment efficacy while reducing costs through an episode-based payment system. Nearly 200 practices across the US use the OCM.

For this retrospective cohort study, researchers evaluated payment data from 12 cancer centers in the southeast United States to determine areas for potential spending reduction. Cost data were evaluated from the pre-chemotherapy period, defined as from diagnosis through treatment initiation, and from 3 OCM treatment episodes, each of which was a 180-day period.

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Among the 3427 included patients, the average age at diagnosis was 72.9 years and 85.5% of patients were Caucasian. Twenty percent of patients underwent at least 3 episodes of care.

During the pre-chemotherapy period, which lasted a median 48 days from diagnosis, the average cost per payment was $16,208, 41% of which was due to inpatient care. Lab tests and pathology averaged at only $1289 per patient; physician services averaged at $1879.

The total cost of care for all 3 OCM episodes was in excess of $157 million with an average per-patient per-episode cost of $25,630; lower average costs per patient were seen with each successive episode. Together, antineoplastic agents and inpatient care cost $75.4 million over all 3 episodes.

The 10 drugs accounting for 61% of antineoplastic agent–costs were used in only 31% of patients. While the most common diagnosis in the cohort was breast cancer (26.6% of patients), rituximab, which was received by only 192 patients, was the single most expensive agent, costing more than $4.3 million over 3 episodes.

The authors concluded that as costs were “heavily driven by antineoplastic drugs and inpatient care,” there is a “need to consider interventions that target both types of spending and the need for protections in payment models to ensure that physicians are not held accountable for drug price increases beyond their control.”

Reference

  1. Rocque GB, Williams CP, Kenzik KM, et al. Where are the opportunities for reducing health care spending within alternative payment models? J Oncol Pract. 2017 Oct 5. doi: 10.1200/JOP.2017.024935 [Epub ahead of print]