Site of Care Impacts Total Costs of Treatment Across Many Cancer Types


Lucio N Gordan, MD, medical director in the division of quality and informatics, Florida Cancer Specialists and Research Institute, shared a variety of data suggesting that the general trend of cancer therapy being moved from the community setting to the hospital outpatient setting has resulted in significant cost increases.

Dr Gordan presented this data at the 2018 Community Oncology Alliance (COA) Conference (April 12, 2018; National Harbor, MD).

In his third year as co-chair of the COA conference, Dr Gordan focused his keynote presentation around the issues associated with site of care for patients with cancer. Various studies that he has been involved with have demonstrated that cost drivers in oncology in the United States have increased across all specialties, not just medical oncology or chemotherapy.

“We have seen a tremendous increase of infusion of chemotherapy by site of service, transitioning from the community to the hospital outpatient setting,” he said in his opening remarks. A particular driver of this shift is the 304B drug discount program, he continued, and the shift has cost Medicare almost 3 million dollars per year.

Dr Gordan noted that while value-based care is necessary, it provides a large burden on community practices.

For many types of cancer (ie, breast, colorectal, and lung), there is “unequivocal” data to suggest that total costs of treatment—including chemotherapy administration, radiation administration, surgery, inpatient visits, and ED visits—are more expensive in the hospital outpatient setting compared with the community setting, according to Dr Gordan. Three studies were shared to support this claim, two of which (JAMA Oncology. 2018;4(4):580-581 and “Lower Costs Associated With Oncology Care Delivered in a Community Setting vs a Hospital Setting: A Matched Cohort Analysis of Patients With Breast, Colorectal, and Lung Cancer”) have been referenced extensively in previous years. The third study, which analyzed site of care cost differences in the age of immunotherapy, will be published soon and was presented by Dr Gordan for the first time during his presentation.

Dr Gordan began discussing this new study by acknowledging that there has been an “explosion” of new therapies (including PD-1 and PD-L1 inhibitors) for breast, lung, and prostate cancers, as well as for melanoma and chronic lymphocytic leukemia, in recent years. The aim of this study was to contribute to a growing body of research that indicates patients receive oncology treatments in the community similar to the hospital setting, but at a lower cost.

Dr Gordan and colleagues found that total costs of care were significantly less in the community setting compared with the hospital setting across the entire patient population as well as when stratified by therapy.


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“Given relatively recent introduction of most immunotherapies, additional assessment for new indications and individual cost components should be further evaluated in the future,” he said.

In his concluding remarks, Dr Gordan presented a call to action for the payers in the audience to push hard for community setting coverage. “Folks like yourselves can move the needle,” he stated.—Zachary Bessette