Integrated Delivery Networks and Associated Costs of Cancer Care


A recent study examined a potential association between system-level integration and longitudinal costs of cancer care.

The study was published in the Journal of Oncology Practice (March 2018;14[3]:e149-e157).

Policy reforms in the Affordable Care Act have required health care integration to improve quality and lower costs.

Deborah R Kaye, MD, Urologic Health Services Research, University of Michigan, and colleagues investigated the trend toward system-level health care integration and the association with longitudinal costs of cancer care. Researchers utilized the Surveillance, Epidemiology, and End Results-Medicare database to identify 428,300 patients with one of 10 common cancers: prostate, bladder, esophageal, pancreatic, lung, liver, kidney, colorectal, breast, or ovarian. Patients were aged 66 to 99 years and presented with cancer from 2007 through 2012.

Researchers attributed each patient to at least one phase of care (ie, initial, continuing, and end of life) based on time from diagnosis until death or end of the study interval. Researchers then aggregated all claims with the primary care diagnosis and identified patients treated in an integrated delivery network for each phase. From there, researchers were able to determine whether care provided in an integrated delivery network was associated with decreased payments across cancers and for each individual cancer by phase as well as across phases.

Dr Kaye and colleagues noted that there were no overall differences in phase-based payments between integrated delivery networks and non-integrated delivery networks. The average adjusted annual payments by phase for integrated delivery networks versus non-integrated delivery networks are shown in the below table:

  Initial (P = .672) Continuing (P = .566) End of life (P = .948)
Integrated $14,194 $2,051 $16,257
Non-integrated $14,421 $2,099 $16,232

Researchers acknowledged that lower payment in integrated delivery networks were observed in select cancer types, including end of life payments for bladder cancer ($11,041 vs $12,331, respectively; P = .008).


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Among the four cancer types with the lowest 5-year survival rates—pancreatic, lung, esophageal, and liver—average expenditures during the initial and continuing phases were lower for patients with liver cancer treated in integrated delivery networks.

Dr Kaye and colleagues concluded that for patients with one of 10 common cancer types, treatment in an integrated delivery network generally is not associated with lower coats during any phase of care.—Zachary Bessette