In the study, cost data on 6,675 patients with breast, lung, or colorectal cancer from July 2010 to June 2015 extracted from the IMS LifeLink database were analyzed as cost per patient per month (PPPM). Patients treated in community clinics were matched 2 to 1 with those treated at hospital clinics on the basis of cancer type, chemotherapy regimen, receipt of radiation therapy, presence of metastatic disease, sex, prior surgery, and geographic region. Most patients (84%) were aged < 65 years. Costs are mean and standardized to 2015 U.S. dollars.
Costs of Care
Total costs of care PPPM were lower across all tumor types in the community setting ($12,548 vs $20,060, P < .001), reflecting lower PPPM medical costs in the community setting ($12,103 vs $19,471, P < .001). Results were similar across cancer types. The increase in medical costs in the hospital cohort was due to increases in both PPPM chemotherapy costs ($4,933 vs $8,443, P <.001) and physician visit costs ($765 vs $3,316, P < .001). The lower chemotherapy cost in the community setting was irrespective of chemotherapy regimen and tumor type.
For the community vs hospital cohort, rates of hospitalization at 72 hours (2.3% vs 2.2%) and 10 days (7.0% vs 7.3%) after chemotherapy did not significantly differ. Patients in the community cohort were less likely to have emergency department visits (hazard ratio = 0.71, P = .02).
The investigators concluded, “We observed significantly increased costs of care for our patient population treated at hospital-based clinics vs those treated at community-based clinics, largely driven by the increased cost of chemotherapy and provider visits in hospital-based clinics. If the site of cancer care delivery continues to shift toward hospital-based clinics, the increased health-care spending for payers and patients should be better elucidated and addressed.”
The study was supported by ION Solutions.
Lucio Gordan, MD, of Florida Cancer Specialists and Research Institute , Division of Quality and Informatics, Gainesville, is the corresponding author for the Journal of Oncology Practice article.
Disclosures: See study authors’ full disclosures at jop.ascopubs.org.