• Am J Manag Care · Mar 2019

    Cost differential of immuno-oncology therapy delivered at community versus hospital clinics.

    • Lucio Gordan, Marlo Blazer, Vishal Saundankar, Denise Kazzaz, Susan Weidner, and Michael Eaddy.
    • Division of Quality and Informatics, Florida Cancer Specialists & Research Institute, 6420 W Newberry Rd, Ste 100, Gainesville, FL 32605. Email: LGordan@flcancer.com.
    • Am J Manag Care. 2019 Mar 1; 25 (3): e66-e70.

    ObjectivesThe site of cancer care delivery has been shown to be associated with the total cost of care. The magnitude of this effect in patients receiving expensive immuno-oncology (I-O) therapies has not been evaluated. We evaluated cost differentials between community-based and hospital-based outpatient clinics among patients receiving I-O therapies.Study DesignThis was a retrospective analysis utilizing Truven MarketScan Commercial and Supplemental Medicare claims databases.MethodsCost data for 3135 patients with non-small cell lung cancer, squamous cell carcinoma of the head and neck, bladder cancer, renal cell carcinoma, or melanoma who received pembrolizumab, nivolumab, and/or ipilimumab between January 1, 2015, and February 14, 2017, were analyzed as cost per patient per month (PPPM). Patients treated within a community setting were matched 2:1 with those treated at a hospital clinic based on cancer type, specific I-O therapy, receipt of radiation therapy, evidence of metastatic disease, gender, age, and evidence of surgery in the preindex period.ResultsMean (SD) total (medical plus pharmacy) PPPM cost was significantly lower for patients treated in a community- versus hospital-based clinic ($22,685 [$16,205] vs $26,343 [$22,832]; P <.001). Lower PPPM medical cost in the community versus hospital setting ($21,382 [$15,667] vs $24,831 [$22,102]; P <.001) was the major driver of this cost differential. Lower total cost was seen regardless of cancer type or I-O therapy administered.ConclusionsTreatment with I-O therapies in community practice is associated with a lower total cost of care compared with that in hospital-based outpatient practices. With the expanding indications of these agents, future research is needed.

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