WellPoint Study Shows Office-based Practices Deliver Less Costly Cancer Care

A retrospective analysis of pharmacy and medical claims conducted by WellPoint shows that the costs to treat and care for cancer patients can be 3% to 14% less, depending on cancer type, when it is provided by oncologist-owned practices versus hospital-owned practices. Findings were presented at the American Society of Clinical Oncology annual meeting in Chicago.

Overall, the researchers identified an 8% gap in costs between the two practice types. Claims for 18,740 commercially-insured members who had breast cancer, colorectal cancer, lung cancer, non-Hodgkin lymphoma, and chronic lymphocytic leukemia were collected and studied by HealthCore, WellPoint’s outcomes research company.

“While the difference is significant, the cause is not completely clear,” said Jennifer Malin, MD, PhD, medical director for oncology at WellPoint, in a news release. “Some of the differential can likely be attributed to higher facility fees paid to hospitals, but we can’t say that hospitals consistently use more expensive tests or therapies as an initial analysis suggests the opposite. More work needs to be done in this area to determine why.”

When actual costs were examined, the researchers found the largest gap in patients with metastatic colorectal cancer. Treatment price averaged $105,093 in oncologist-owned practices and $113,812 in hospital-owned practices.

Cost differences between the two types of practices were statistically significant except in metastatic breast cancer. Differences between the two practice settings were observed in early breast cancer (8%), metastatic lung cancer (7%), metastatic colorectal cancer (8%), and non-Hodgkin lymphoma and chronic lymphocytic leukemia (14%).

“The differences in costs make an obvious impact in the overall economic burden to pay for oncology care,” said Maxine Fisher, HealthCore’s associate research director in a release. “Among all the services, we saw the greatest cost gap between the two practice types in outpatient office visits and outpatient services which should be further explored.”

The study included overall cancer costs, such as cancer-related evaluations and interventions, cancer drugs and infusions, front-line treatment regimens, granulocyte-colony stimulating factor drugs use during the follow-up period and chemotherapy or hospitalizations prior to 30 days before death.

Funding for this open architecture analysis was provided by Genentech, a member of the Roche Group. The analysis reviewed claims from January 1, 2006 through August 31, 2012.