Effects of rising drug costs on efforts to control overall cost at a large academic cancer center.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 2-2
Author(s):  
Kerin B. Adelson ◽  
Maureen Canavan ◽  
Susanna N. Supalla ◽  
Tannaz Sedghi ◽  
Basit Chaudhry ◽  
...  
Keyword(s):  
Acute Care ◽  
Cost Of Care ◽  
Drug Costs ◽  
Cancer Center ◽  
Historical Period ◽  
Pharmaceutical Pricing ◽  
Total Cost ◽  
The Mean ◽  
Mean Cost ◽  
Post Acute Care

2 Background: Value-based payment programs like the Oncology Care Model (OCM) have focused efforts to reduce costly acute care use through improvements in access and coordination rather than targeting the exponential rise in pharmaceutical pricing. We assessed how participation in OCM affected total cost of cancer care at a large academic cancer center. Methods: Using Medicare claims for Yale-Smilow Cancer Hospital, an NCI-designated cancer center with an academic hub and 10 community practices, we identified episodes for chemotherapy initiated during a historical period (pre-OCM, 2012-2015) and performance period (post-OCM, 2016-2017) following OCM criteria to identify total cost of care. We reported frequency of utilization categories, the mean cost per episode, the proportion of total cost attributed to each utilization category and compared pre- and post-participation periods. Results: There were 8,843 episodes during the historical period and 6,679 episodes during the performance period. The mean total cost per episode increased from $28,645 to $32,666, but this was less than the Medicare-defined expected increase (target price). Between the two periods, the percentage of total episodes decreased for emergency department (ED) use from 36% to 33%, inpatient care from 33% to 29%, and post-acute care from 28% to 25% (p < 0.01). Mean costs of drugs per episode increased by 27% between periods, and from 52% to 58% of total cost of care (p < 0.01). While mean cost per episode for ED, inpatient, and post-acute care remained stable, the mean cost per episode for antineoplastics increased 39% from $10,676 to $14,843. Conclusions: After implementing OCM, we beat the Medicare target largely by decreasing acute care use and stabilizing the cost of hospitalizations and ED; however, actual cost increased largely due to pharmaceutical spending. Because drug costs were the largest proportion of overall cost of care, future value-based models must address the rising cost of pharmaceuticals. [Table: see text]

The impact of clinical trial (CTr) participation on savings performance in the oncology care model (OCM).

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19367-e19367
Author(s):  
Kerin B. Adelson ◽  
Maureen Canavan ◽  
Sophia Mun ◽  
Cary Philip Gross ◽  
Naralys Sinanis ◽  
...  
Keyword(s):  
Total Sample ◽  
Cost Of Care ◽  
Drug Costs ◽  
Lower Percentage ◽  
Cancer Center ◽  
Chi Square ◽  
Total Cost ◽  
The Mean ◽  
And Performance ◽  
The Impact

e19367 Background: The OCM is a Centers for Medicare and Medicaid Services (CMS) alternative payment model, which seeks to curb costs while improving care for patients receiving systemic cancer therapy. CMS models the expected total cost (spending target) for each 6-month episode using historical, geographic and clinical factors including CTr participation. We evaluated the relationship between CTr participation, actual cost of care and performance in the OCM. Methods: We used claims for OCM episodes attributed to the Yale Cancer Center between July 2016 and July 2018. We stratified episodes by CTr participation and used t-tests and chi-square tests to compare total cost, drug costs (Part B and D) and whether actual episode costs were above or below CMS targets. Analyses were conducted for the total sample, and among the most common cancer types. Results: Among 9,387 OCM episodes (5,270 unique patients), 815 (8.7%) episodes involved a CTr. Among non-CTr patients, the mean Medicare cost per episode ($32,909) was modestly higher than the mean episode spending target ($31,746; p < 0.001), while in the CTr group, the mean Medicare cost per episode ($36,590) was substantially lower than the mean episode spending target ($48,124 p < 0.001). Mean drug cost was lower with CTr vs without ($15,650 vs $19,587, p < 0.001). Drug costs also accounted for a lower percentage of total costs for episodes with CTr vs not (41% vs 57%). CTr episodes were more likely to meet spending targets than non-CTr episodes (66% vs 56%, p < 0.001) overall and in breast, lung, and myeloma cancers, although only statistically significant for lung cancer (76% CTr vs 48% non-CTr, p < 0.001). Mean difference between target and actual costs was greater for episodes with CTr (- $11,534) than for episodes without CTr (+ $1,163) (p < 0.001). Conclusions: On average, episodes with CTr participation had substantially lower costs compared with their spending targets, while non-CTr episodes had slightly higher costs compared with their spending targets. While total cost of care was higher for episodes with CTr (as the CMS model predicts), drug costs were significantly lower. As drugs comprise a large proportion of total cost, lower drug costs in CTr episodes likely contribute to savings. Additional research should explore whether other OCM centers with higher rates of CTr participation are more likely to meet spending targets in value-based payment models.

scholarly journals Post-Acute Care for Medicare Beneficiaries in Accountable Care Organizations

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 19-19
Author(s):  
Erin Colligan ◽  
Brittany Branand
Keyword(s):  
Acute Care ◽  
Inpatient Rehabilitation ◽  
Cost Of Care ◽  
Accountable Care Organizations ◽  
Care Utilization ◽  
Accountable Care ◽  
Total Cost ◽  
Transitions In Care ◽  
The Impact ◽  
Post Acute Care

Abstract Post-acute care (PAC) is a component of health-care utilization and spending that is subject to the discretion of providers. Prior research has demonstrated that Accountable Care Organizations (ACOs) recognize PAC as a logical target for increased efficiency and cost savings. As part of the evaluation of the Centers for Medicare & Medicaid Services (CMS) Next Generation ACO (NGACO) Model, we investigated NGACOs’ approaches to PAC services and the impact of these efforts on utilization and cost using a mixed-methods study design. We conducted interviews and surveys with NGACO leadership and providers and performed a difference-in-differences analysis of utilization and spending based on Medicare claims data. We found that NGACOs focused specifically on establishing partnerships with skilled nursing facilities (SNF) to facilitate transitions in care by establishing new channels of communication, sharing performance data, embedding staff in SNFs, and (in some cases) sharing financial risk. We observed a statistically significant decrease in SNF spending, a trend toward fewer SNF days, and statistically significantly lower expenditures for other PAC settings (e.g., inpatient rehabilitation and long-term acute care facilities). These findings suggest that NGACOs have contributed to improving transitions in care and diverting beneficiaries from intensive PAC settings. Nonetheless, the reduction in PAC spending alone did not translate to a decline in total cost of care. Future ACOs may need to expand their focus to the inpatient utilization and spending that precedes PAC in order to impact total cost of care.

A community oncology practice financial experience in oncology care model pilot (OCM).

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19379-e19379
Author(s):  
Adil Jamal Akhtar ◽  
Jeffrey H. Margolis ◽  
Karna Sheth ◽  
Karma Maxwell ◽  
Andrew A. Muskovitz ◽  
...  
Keyword(s):  
Skilled Nursing Facility ◽  
Health Agency ◽  
Cost Of Care ◽  
Drug Costs ◽  
Historical Period ◽  
Cancer Type ◽  
Breast Cancers ◽  
Cost Category ◽  
Total Cost ◽  
The Impact

e19379 Background: Oncology Division of Michigan Health Professionals (MHP) participates in OCM, which requires effort from all MHP OCM providers to coordinate care at same or lower cost to Medicare. Palliative Care, Care Management, and End of Life Care programs established by MHP, in collaboration with Premiere Hospice and Integra Connect, have shown cost and quality benefits in the OCM patients. Quality improvement initiatives included monthly OCM provider meetings to review OCM results, identify cost & quality opportunities, and to design training and education sessions. In order to assess the impact of such a concerted initiative, this study aims to evaluate MHP OCM provider impact in OCM total cost of care relative to historical period. Methods: Retrospective review of reconciliation results provided by Centers for Medicare and Medicaid Innovation (CMMI) for OCM performance periods 1-4 (pp1-4). Total cost of care (ACTUAL) and cost categories were the summarized and adjusted expenditures during 6-month OCM period as reported by CMMI. ACTUAL and cost category experience was compared by OCM performance period to the trended-mean of matched historical OCM-eligible patients (Baseline Episodes from CMMI). Patients were matched by cancer type, comorbidity count, age group, radiation, surgery, and low-intensity/-risk cancer sub-type for prostate, bladder and breast cancers. Results: The largest pp1-4 cost category reductions were acute inpatient ($2.2M), physician services excluding drug-cost, imaging and labs ($1.2M), skilled nursing facility ($0.5M), ancillary which consists of imaging and lab ($0.5M), inpatient rehab ($0.3M), home health agency ($0.3M), radiation oncology ($0.1M). The largest pp1-4 increase in OCM expense relative to historical was Part D Drugs ($1.7M). Conclusions: MHP decreased non-drug costs by $5.1M compared to historical cost for matched patients. OCM costs were lower in facility (hospital and SNF) and physician sites of care. Drug costs increased by $1.7M. Study was limited by OCM claims available as of December 2019. Results may be refreshed as more data becomes available. [Table: see text]

scholarly journals Potato Late Blight in the Columbia Basin: An Economic Analysis of the 1995 Epidemic

Plant Disease ◽  
1997 ◽  
Vol 81 (1) ◽  
pp. 103-106 ◽  
Author(s):  
D. A. Johnson ◽  
T. F. Cummings ◽  
P. B. Hamm ◽  
R. C. Rowe ◽  
J. S. Miller ◽  
...  
Keyword(s):  
Late Blight ◽  
Management Practice ◽  
Columbia Basin ◽  
Copper Hydroxide ◽  
Total Cost ◽  
Late Season ◽  
The Mean ◽  
The Cost ◽  
Mean Cost ◽  
First Time

The cost of managing late blight in potatoes during a severe epidemic caused by new, aggressive strains of Phytophthora infestans in the Columbia Basin of Washington and Oregon in 1995 was documented. The mean number of fungicide applications per field varied from 5.1 to 6.3 for early- and midseason potatoes, and from 8.2 to 12.3 for late-season potatoes in the northern and southern Columbia Basin, respectively. In 1994, a year when late blight was not severe, the mean number of fungicide applications per field made to early- and midseason potatoes was 2.0; whereas late-season potatoes received a mean of 2.5 applications. The mean per acre cost of individual fungicides applied varied from $4.90 for copper hydroxide to $36.00 for propamocarb + chlorothalonil. Total per acre expenses (application costs plus fungicide material) for protecting the crop from late blight during 1995 ranged from $106.77 to $110.08 for early and midseason potatoes in different regions of the Columbia Basin and from $149.30 to $226.75 for lateseason potatoes in the northern and southern Columbia Basin, respectively. Approximately 28% of the crop was chemically desiccated before harvest as a disease management practice for the first time in 1995, resulting in an additional mean cost of $34.48/acre or $1.3 million for the region. Harvested yields were 4 to 6% less than in 1994. The total cost of managing late blight in the Columbia Basin in 1995 is estimated to have approached $30 million.

scholarly journals The estimated cost of surgically managed isolated traumatic head injury secondary to road traffic accidents

2018 ◽  
Vol 44 (5) ◽  
pp. E7 ◽  
Author(s):  
Xinli You ◽  
Boon S. Liew ◽  
Azmin K. Rosman ◽  
Kamarul Imran Musa ◽  
Zamzuri Idris ◽  
...  
Keyword(s):  
Head Injury ◽  
Severe Head Injury ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Cost Of Care ◽  
Road Traffic Accidents ◽  
Traumatic Head Injury ◽  
Traumatic Head ◽  
The Mean ◽  
Mean Cost

OBJECTIVETraumatic brain injury due to road traffic accidents occurs mainly in the younger age group in which injury-related disability leads to long-term impact on employment and economic and social consequences across the lifespan. This study was designed to assign a monetary cost (in Malaysian ringgits [RM]) to the treatment of patients with surgically treated isolated traumatic head injury as determined up to 1 year after injury.METHODSRelevant resource items used were identified and valued using the direct measurement of costs method, cost accounting methods, standard unit costs method, fees, charges and/or market prices method. These values were then tabulated to generate the total costs for each patient, via a combination of macro-costing and micro-costing methods. Malaysian currency values were converted to US dollars according to the average conversion rate for the period from January to May 2016: RM1 = US$0.2452.RESULTSThis costing study analyzed data from 49 patients. The estimated cost for the 1st year of care for all patients was RM1,471,919.80 (US$360,914.735), with a mean (± SD) cost per case of RM30,039.18 ± 22,986.25 or $7365.61 ± $5636.23. The mean cost of care per case was RM11,041.35 ± 10,936.88 or $2707.34 ± $2681.72 for mild head injury, RM32,550.00 ± 20,998.76 or $7981.26 ± $5148.90 for moderate head injury, and RM36,917.86 ± 23,697.34 or $9052.26 ± $5810.59 for severe head injury. Severe head injury (p = 0.001), sustaining 2 or more intracranial pathologies (p = 0.01), having a poor Glasgow Outcome Scale (GOS) score (GOS score 1–3) (p = 0.02), requiring a tracheostomy (p < 0.001), and contracting pneumonia (p < 0.001) were significantly associated with higher cost. Logistic regression analysis revealed that cost of care increased by RM591.60 or $145.06 per year increment of age (β = RM591.60, p = 0.05).CONCLUSIONSThe mean cost of treatment for traumatic head injury is high compared to the per capita income of RM37,900 in 2016. The cost values generated in this study provide baseline cost estimates that the authors hope will be used as a guide to determine where adequate funding should be allocated to provide timely and appropriate delivery of care.

scholarly journals Implementation strategy and cost of Mozambique’s HPV vaccine demonstration project

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Caroline Soi ◽  
Joseph B. Babigumira ◽  
Baltazar Chilundo ◽  
Vasco Muchanga ◽  
Luisa Matsinhe ◽  
...  
Keyword(s):  
Hpv Vaccine ◽  
Annual Cost ◽  
Implementation Strategy ◽  
National Level ◽  
Vaccine Dose ◽  
Demonstration Project ◽  
Total Cost ◽  
School Based ◽  
The Mean ◽  
Mean Cost

Abstract Background Cost is an important determinant of health program implementation. In this study, we conducted a comprehensive evaluation of the implementation strategy of Mozambique’s school-based HPV vaccine demonstration project. We sought to estimate the total costs for the program, cost per fully immunized girl (FIG), and compute projections for the total cost of implementing a similar national level vaccination program. Methods We collected primary data through document review, participatory observation, and key informant interviews at all levels of the national health system and Ministry of Education. We used a combination of micro-costing methods—identification and measurement of resource quantities and valuation by application of unit costs, and gross costing—for consideration of resource bundles as they apply to the number of vaccinated girls. We extrapolated the cost per FIG to the HPV-vaccine-eligible population of Mozambique, to demonstrate the projected total annual cost for two scenarios of a similarly executed HPV vaccine program. Results The total cost of the Mozambique HPV vaccine demonstration project was $523,602. The mean cost per FIG was $72 (Credibility Intervals (CI): $62 - $83) in year one, $38 (CI: $37 - $40) in year two, and $54 CI: $49 - $61) for years one and two. The mean cost per FIG with the third HPV vaccine dose excluded from consideration was $60 (CI: $50 - $72) in year one, $38 (CI: $31 - $46) in year two, and $48 (CI: $42 - $55) for years one and two. The mean cost per FIG when only one HPV vaccine dose is considered was $30 (CI: $27 - $33)) in year one, $19 (CI: $15–$23) in year two, and $24 (CI: $22–$27) for both years. The projected annual cost of a two-and one-dose vaccine program targeting all 10-year-old girls in the country was $18.2 m (CI: $15.9 m - $20.7 m) and $9 m (CI: $8 m - $10 m) respectively. Conclusion National adaptation and scale-up of Mozambique’s school-based HPV vaccine strategy may result in substantial costs depending on dosing. For sustainability, stakeholders will need to negotiate vaccine price and achieve higher efficiency in startup activities and demand creation.

scholarly journals Expenditure survey on continued veno-venous hemodialysis procedure in the intensive care unit

2007 ◽  
Vol 15 (6) ◽  
pp. 1138-1143 ◽  
Author(s):  
Lígia Maria dal Secco ◽  
Valéria Castilho
Keyword(s):  
Total Expenditure ◽  
Procedure Time ◽  
Time Duration ◽  
Total Cost ◽  
Acute Renal Insufficiency ◽  
Male Patients ◽  
The Mean ◽  
Procedure Duration ◽  
Mean Cost ◽  
Dialytic Treatment

This study aimed to characterize patients submitted to dialytic treatment with CVVHD in ICUs; monitor procedure time duration; estimate nurses' labor wages and; estimate the direct procedures mean costs. The study was developed in a public teaching hospital located in São Paulo, Brazil. A total of 93 procedures performed in 50 patients composed the sample. The results showed the predominance of male patients (62%); mean age was 60.8 years old; ICU hospitalization time was 19.2 days; 86% of the patients died; 76% of the patients presented acute renal insufficiency and, mean procedure time per patient was 1.9. The mean procedure duration was 26.6 hours. The mean cost of nurses' wages were R$ 592.04 which represented 28.7% of the total cost. The mean total expenditure was R$ 2,065.36 ranging from R$ 733.65 to R$ 6,994.18.

Cost of colon cancer care: Results of nationwide inpatient sample (NIS) data.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 692-692 ◽  
Author(s):  
Pranshu Bansal ◽  
Ian Rabinowitz ◽  
Yanis Boumber ◽  
Dhruv Bansal
Keyword(s):  
Colon Cancer ◽  
Cancer Care ◽  
Hospital Admissions ◽  
Hospital Costs ◽  
Cost Of Care ◽  
Inpatient Setting ◽  
Hospital Data ◽  
For Profit ◽  
The Mean ◽  
Mean Cost

692 Background: Cost of cancer care including colon cancer continues to rise. Most of the recent advances in colon cancer inlcude biologics and targeted agents which are adminstered in an oupatient setting and more commonly thought to be responsible for increasing economic burden. Cost of care for cancer patients in an inpatient setting however continues to be a significant factor that needs to be identified better to help adopt cost effective quality improvement in future. Methods: We used NIS to extract data for patients hospitalized with primary diagnosis of colon cancer using clinical classification software code 14, and corresponding ICD9 codes for the years 2003-2013. ICD codes for colorectal and rectal cancer were eliminated. NIS is a nationally representative survey of hospitalizations conducted by the Healthcare Cost and Utilization Project. It represents 20% of all hospital data in US. Trend of rate of hospitalization, mean length of stay (LOS), mean cost of hospitalization and mean cost of hospitalization based on owner type- government, private not for profit (PNFP) and private for profit (PFP) was performed. Results: From the year 2003 to 2013 rate of hospitalizations for colon cancer decreased from 37.4 to 28.1 per 100,000 hospital admissions. Mean LOS declined from 9.06 to 7.76 between 2003-2013. In the same time period the mean cost of hospital stay increased from $39,430 to $73,219. The mean cost of hospitalization based on owner type in 2003 was government $33,507; PNFP $33,735 and PFP was $55,553 and in 2013 the mean costs were $63,194; $68,555 and $107,428 respectively. Conclusions: In the decade of 2003-2013 the rate of hospitalization decreased by approximately 25%, LOS decreased by 14% but the mean cost of hospitalization continued to increase throughout the decade with a mean increase of approximately 85% in hospital costs. The increase was observed across the spectrum of all owner types with the maximum increase of 104% in PNFP followed by PFP owner type at 93%, national inflation rate was 26% during this time. Progress made in decreasing LOS has not directly translated into reducing hospital costs and further studies focusing on factors in addition to cost of biologic agents that contribute to cancer care costs should be considered.

The association between clinical trial (CT) participation, pharmaceutical costs, and savings performance in the Oncology Care Model (OCM).

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 2-2
Author(s):  
Kerin B. Adelson ◽  
Maureen Canavan ◽  
Sophia Mun ◽  
Cary Philip Gross ◽  
Naralys Sinanis ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Total Sample ◽  
Drug Costs ◽  
Cancer Center ◽  
Cancer Therapies ◽  
Chi Square ◽  
Part D ◽  
Lower Drug ◽  
The Mean ◽  
And Performance

2 Background: The OCM is a Centers for Medicare and Medicaid Services (CMS) alternative payment model, which seeks to curb costs while improving care for patients receiving systemic cancer therapy. CMS models the expected spending target for each 6-month episode using historical, geographic and clinical factors, including CTr participation. We evaluated the relationship between CTr participation, drug costs and performance in the OCM. Methods: We used claims for OCM episodes attributed to the Yale Cancer Center between July 2016 and July 2018. We stratified episodes by CTr participation and used t-tests and chi-square tests to compare total cost, drug costs (Part B, Part D and novel cancer therapies) and whether observed episode costs were above or below CMS targets. Analyses were conducted for the total sample and among the most common cancer types. Results: Among 9,387 OCM episodes (5,270 unique patients), 815 (8.7%) episodes involved a CTr. Among non-CTr patients, the mean Medicare cost per episode ($32,909) was modestly higher than the mean episode spending target ($31,746; p < 0.001), while in the CTr group, the mean Medicare cost per episode ($36,590) was substantially lower than the mean episode spending target ($48,124 p < 0.001). CTr episode costs were more likely to be under spending targets than non-CTr episodes (66% vs 56%, p < 0.001) overall and in breast, lung, and myeloma cancers, although only statistically significant for lung cancer (76% CTr vs 48% non-CTr, p < .001). Overall, non-CTr had significantly higher mean Part D drug costs per episode ($8,441 vs $3,893, p < 0.001), which was also noted among patients with lung cancer, ovarian cancer and lymphoma. Non-CTr episodes were also associated with higher mean novel therapies cost ($5,736) compared with CTr patient episodes ($4,346, p = 0.013). When comparing the sum of all other expenditures, CTr episodes were significantly associated with higher non-pharmaceutical expenditures than non-CTr episodes ($20,940 vs. $13,323, p < 0.001) overall. Conclusions: Episodes with CTr participation out-performed non-CTr episodes in achieving savings relative to CMS spending targets. Savings were driven by lower drug costs for the CTr episodes, particularly in the categories of Part D and novel cancer therapies. This suggests that CTr enrollment shifts costs for expensive pharmaceuticals away from CMS and toward the CTr study sponsor. Further research should explore whether this finding is generalizable to other cancer centers and payment models.

scholarly journals Cost-effectiveness of using stone cone, balloon dilator, stone basket, and entrapment device in ureteroscopic laser lithotripsy for ureteric stones

2021 ◽  
Vol 49 (12) ◽  
pp. 030006052110610
Author(s):  
Kürşat Çeçen
Keyword(s):  
Laser Lithotripsy ◽  
Secondary Treatment ◽  
Auxiliary Equipment ◽  
Total Cost ◽  
End Of Treatment ◽  
Significant Difference ◽  
Total Treatment ◽  
The Mean ◽  
Mean Cost ◽  
First Time

Objective To evaluate the costs and stone-free rates of ureteroscopic laser lithotripsy (ULL) performed with and without auxiliary equipment and to compare first-time ULL with total treatment. Methods One hundred patients who underwent first-time ULL without the use of auxiliary equipment because its unavailability comprised the no-device ULL (ndULL) group. Additionally, 100 patients who underwent first-time ULL with the use of auxiliary equipment when necessary comprised the device ULL (dULL) group. Results In the ndULL and dULL groups, the stone-free rates after first-time ULL were 72% and 94% and the mean cost was US $1037 ± 15.10 and US $1452 ± 19.80 per case, respectively, with a statistically significant difference. The stone-free rates at the end of treatment were 98% and 99%, respectively, without a statistically significant difference. When secondary treatment costs were added to the first ULL costs after failed treatment, the mean total cost was US $1625 ± 12.60 in the ndULL group and US $1566 ± 11.01 in the dULL group without a statistically significant difference. Conclusions The stone-free rates and costs after first-time ULL were significantly different between the groups. However, after total treatment, there was no statistically significant difference between the two groups.

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