Oncology value based payment models: Where are the savings opportunities?

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 69-69
Author(s):  
Era Kim Oh ◽  
Jon Maguire ◽  
Tracy E. Spinks ◽  
Kristen K. McNiff Landrum ◽  
Jennifer Malin
Keyword(s):  
Radiation Therapy ◽  
Statistical Significance ◽  
Medical Costs ◽  
Cancer Diagnostics ◽  
Cancer Surgery ◽  
Inpatient Admission ◽  
Cancer Type ◽  
Chemotherapy Drugs ◽  
National Cohort ◽  
The Impact

69 Background: Oncology practices are increasingly participating in value-based payment (VBP) arrangements; however, there is limited information on where practices have the greatest impact on reducing medical costs. Methods: United Healthcare (UHC) conducted a pilot to evaluate a VBP consisting of an episode fee, eliminating drug margin, and shared savings. The pilot was limited to members with breast, lung or colon cancer enrolled in UHC’s commercial plans. We compared total medical cost (TMC) per 120-day episode calculated from paid claims amounts for the pilot practices with a concurrent national cohort for the performance period (9/2015-9/2019) and a baseline period (1/2013-3/2015) using a difference-in-differences technique with a generalized linear regression model, adjusting for age, gender, cancer type and stage (adjuvant vs. metastatic), comorbidities, cancer surgery, radiation therapy, novel therapy, duration of therapy, and region. We categorized claims into 6 categories and estimated the impact of the VBP on costs: chemotherapy/drugs, radiation therapy, cancer surgery, cancer diagnostics, other cancer-related and other non-cancer related. In addition, we evaluated the difference in acute inpatient admission rates. Results: Patient treated in the pilot practices contributed 2,647 episodes of a total of 73,352 episode during the performance period, weighted equally between adjuvant and metastatic disease (Table). The adjusted TMC per 120-day episode was $36,434 for the national cohort and $37,215 for the participating clinics at baseline and $50,773 and $41,416, respectively during the performance period, resulting in an average decrease in TMC of $9,687 or a 20% reduction; although this varied significantly by stage and cancer type. The relative decrease in medical costs by category ranged from 13% for chemotherapy/drugs to 33% for cancer surgery and an increase in costs associated with cancer diagnostics of 7%; however, chemotherapy/drug were still associated with the largest absolute decrease in costs ($2,941). Practices participating in the pilot had a 24.7% decrease in the number of acute inpatient admissions and 12.6% decrease in the number of inpatient admission days; however, this did not reach statistical significance. Conclusions: Overall, practices participating in a VBP pilot with a commercial health plan decreased TMC per episode by 20% with savings across all cost categories except for cancer diagnostics.[Table: see text]

Write to recover: The impact of group led creative writing on behavioral health outcomes in cancer patients.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11536-11536
Author(s):  
Darya Nesterova ◽  
Junjia Zhu ◽  
Courtney Kramer ◽  
Monali K. Vasekar ◽  
Jolene Collins ◽  
...  
Keyword(s):  
Creative Writing ◽  
Cancer Patients ◽  
Statistical Significance ◽  
Mental Wellbeing ◽  
Cancer Type ◽  
Depression And Anxiety ◽  
Emotional Wellbeing ◽  
Post Intervention ◽  
Significance Level ◽  
The Impact

11536 Background: The diagnosis of cancer can adversely affect mental wellbeing. In addition to treating cancer, the emotional wellbeing of patients must simultaneously be addressed. A previous pilot exploring the feasibility of creative writing workshop (CWW) in cancer patients showed apositive effect on patients’ mental health. Methods: To longitudinally evaluate the efficacy of CWW on mood, we conducted a phase II study with cancer patients (any stage, any cancer type); randomized 2:1 to CWW vs. active control (AC). Patients in the CWW arm attended at least 4, 1.5-hour bi-monthly CWW x 8 wks, whereas AC patients completed independent writing at home with the help of a book (bi-monthly x 8wks). We used validated tools, [Emotional Thermometer Scales (ETS), PHQ-9, GAD-7] to assess changes in overall mood, depression, and anxiety. Primary end point: a) ETS scores before and after intervention b) Changes in depression and anxiety based on PHQ-9 and GAD-7 scores. We present results from ETS scores. Descriptive statistics were generated for these quantitative scales measured in each group, pre and post intervention. Comparisons between groups (gp) were made using Wilcoxon Rank-sum tests. All tests were two sided and the statistical significance level used was 0.05. Results: Amongst evaluable patients, N of 50 (demographics in table below), twenty-six patients in the CWW gp attended at least one class and 19 attended at least 4 classes. Patients in CWW showed significant mood improvement vs. AC when comparing the final overall ETS (p=0.0063). Three of the five sub-scale ETS scores were significantly lower for the CWW vs. AC gp: anxiety (p=0.0027), depression (p=0.0009), and anger (p=0.0027). Conclusions: Group led CWW have a positive effect on mood. Our results suggest potential therapeutic benefit of this intervention on the emotional wellbeing of cancer patients. Larger studies are needed to evaluate the effect of CWW in cancer patients. Clinical trial information: NCT03536702. [Table: see text]

scholarly journals The Coronavirus Disease Pandemic 2019 [COVID-19]: Impact on NHS England PET-CT Scanning 

2020 ◽  
Author(s):  
Wai Lup Wong ◽  
Peter Ross ◽  
Kevin Peters ◽  
Marion Frenz ◽  
Tong Hai ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Oesophageal Cancer ◽  
Statistical Significance ◽  
Ct Scanning ◽  
Initial Diagnosis ◽  
Cancer Type ◽  
Pet Ct ◽  
Cancer Types ◽  
Rate Of Decline ◽  
The Impact

Abstract Purpose To examine the impact of the COVID-19 pandemic on PET-CT scanning activity across England. Methods Monthly PET-CT scanning activity was collected from 41/48 NHS England provider sites. Data from 31/41sites was stratified by non-oncology/oncology and cancer type. Lung cancer and lymphoma activity was split into specific indications. The data was compiled in Excel and analysed using Stata software to assess distribution and statistical significance of variation in activity comparing levels before and during the COVID-19 pandemic. Results In April and May 2020 a 32% and 31% decrease in activity was observed; a larger decrease for non-cancer compared with cancer PET-CT. In June 2020 PET-CT activity started to recover with 6% fewer scans recorded compared with June 2019. Decrease and recovery varied according to cancer types. Of the six most common indications for PET CT, lung and oesophageal cancer had the largest decrease in activity: lung -29%, -45% and oesophagus -43%, -59% in April and May respectively, and slowest recovery, -23%, -26% respectively in June. By contrast, lymphoma and melanoma showed the smallest decrease: lymphoma -14%, -9%; melanoma -16%, +5% in April and May respectively, and fastest recovery +12% lymphoma +14% respectively. Specifically, lung cancer PET-CTs related to initial diagnosis and staging saw the largest fall and slowest recovery compared with PET-CTs for people with known lung cancer. Conclusions There was considerable variation in the rate of decline and recovery in PET-CT scanning across cancer types and specific indications related to the cancer type. The causes for the variation remain to be explained.

scholarly journals Airway, voice and swallow outcomes following endotracheal intubation and mechanical ventilation for COVID-19 pneumonitis: preliminary results of a prospective cohort study

2020 ◽  
Author(s):  
Benjamin Miller ◽  
Chrysostomos Tornari ◽  
Kelvin Miu ◽  
Andrew Slack ◽  
Patrick Murphy ◽  
...  
Keyword(s):  
Cohort Study ◽  
Critical Illness ◽  
Speech Therapy ◽  
Statistical Significance ◽  
Primary Outcome Measure ◽  
Inpatient Admission ◽  
Tertiary Institution ◽  
Short Period ◽  
The Impact ◽  
Therapy Clinic

Abstract Introduction: The coronavirus pandemic has resulted in unprecedented rates of patients requiring intubation and ventilation over a short period of time. The authors present 3-month data on airway, voice and swallow outcomes for this cohort to better understand the impact of COVID-19 critical illness on laryngotracheal morbidity. Methods: An observational cohort study was performed on all patients discharged following critical illness at our tertiary institution over a 2-month period (1st March 2020 - 30th April 2020). Patients were stratified on the basis of primary diagnosis: COVID-19 pneumonitis, Non-COVID-19 respiratory failure and non-respiratory. Our primary outcome measure was reported airway, voice, and swallow dysfunction during inpatient admission and on 6-12 week Critical Illness Recovery Clinic follow up. Endoscopic findings of patients referred onward to our Multidisciplinary Laryngology-Speech Therapy Clinic were recorded.Results: 141 patients were included in our study. During inpatient admission there were no statistically significant differences in reported rates of airway, voice, or swallow dysfunction. In Critical Illness Recovery Clinic, there were markedly higher rates of reported airway, voice and swallow dysfunction in the COVID-19 pneumonitis cohort, although these rates only reached statistical significance in respect to airway outcomes (airway p=0.038, voice p=0.064, swallow p=0.240). 100% of patients reviewed to date in the Laryngology-Speech Therapy Clinic following COVID-19 critical illness had clinically significant laryngeal pathology.Conclusion: Our data highlights an impending surge in COVID-19 related laryngotracheal morbidity. Robust, prospective screening and clear referral pathways for all patients following COVID-19 critical illness are essential to identifying and managing this cohort.

scholarly journals Collateral damage: the impact on cancer outcomes of the COVID-19 pandemic

2020 ◽  
Author(s):  
Amit Sud ◽  
Michael Jones ◽  
John Broggio ◽  
Chey Loveday ◽  
Bethany Torr ◽  
...  
Keyword(s):  
Cancer Research ◽  
Healthcare Resource ◽  
Cancer Diagnostics ◽  
Cancer Surgery ◽  
Patient Delay ◽  
Term Survival ◽  
Health Crisis ◽  
Life Years ◽  
The Impact

ABSTRACTBackgroundCancer diagnostics and surgery have been disrupted by the response of healthcare services to the COVID-19 pandemic. Progression of cancers during delay will impact on patient long-term survival.MethodsWe generated per-day hazard ratios of cancer progression from observational studies and applied these to age-specific, stage-specific cancer survival for England 2013-2017. We modelled per-patient delay of three months and six months and periods of disruption of one year and two years. Using healthcare resource costing, we contextualise attributable lives saved and life years gained from cancer surgery to equivalent volumes of COVID-19 hospitalisations.FindingsPer year, 94,912 resections for major cancers result in 80,406 long-term survivors and 1,717,051 life years gained. Per-patient delay of six months would cause attributable death of 10,555 of these individuals with loss of 205,024 life years. For cancer surgery, average life years gained (LYGs) per patient are 18·1 under standard conditions and 15·9 with a delay of six months (a loss of 2·3 LYG per patient). Taking into account units of healthcare resource (HCRU), surgery results on average per patient in 2·25 resource-adjusted life years gained (RALYGs) under standard conditions and 1·98 RALYGs following delay of six months. For 94,912 hospital COVID-19 admissions, there are 474,505 LYGs requiring of 1,097,937 HCRUs. Hospitalisation of community-acquired COVID-19 patients yields on average per patient 5·0 LYG and 0·43 RALYGs.InterpretationDelay of six months in surgery for incident cancers would mitigate 43% of life years gained by hospitalisation of an equivalent volume of admissions for community acquired COVID-19. This rises to 62% when considering resource-adjusted life-years gained. To avoid a downstream public health crisis of avoidable cancer deaths, cancer diagnostic and surgical pathways must be maintained at normal throughput, with rapid attention to any backlog already accrued.FundingBreast Cancer Now, Cancer Research UK, Bobby Moore Fund for Cancer Research, National Institute for Health Research (NIHR)

Percutaneous Coronary Intervention in Patients with Diabetes and Multivessel or Left Main Disease – a Review

2012 ◽  
Vol 7 (1) ◽  
pp. 37
Author(s):  
Donald E Cutlip ◽  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Statistical Significance ◽  
Bare Metal Stents ◽  
Coronary Intervention ◽  
Metal Stents ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
Patients With Diabetes ◽  
The Impact

Coronary artery disease in patients with diabetes is frequently a diffuse process with multivessel involvement and is associated with increased risk for myocardial infarction and death. The role of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) in patients with diabetes and multivessel disease who require revascularisation has been debated and remains uncertain. The debate has been continued mainly because of the question to what degree an increased risk for in-stent restenosis among patients with diabetes contributes to other late adverse outcomes. This article reviews outcomes from early trials of balloon angioplasty versus CABG through later trials of bare-metal stents versus CABG and more recent data with drug-eluting stents as the comparator. Although not all studies have been powered to show statistical significance, the results have been generally consistent with a mortality benefit for CABG versus PCI, despite differential risks for restenosis with the various PCI approaches. The review also considers the impact of mammary artery grafting of the left anterior descending artery and individual case selection on these results, and proposes an algorithm for selection of patients in whom PCI remains a reasonable strategy.

Dietary Patterns: A New Therapeutic Approach for Depression?

2019 ◽  
Vol 20 (2) ◽  
pp. 123-129 ◽  
Author(s):  
Mariana Jesus ◽  
Tânia Silva ◽  
César Cagigal ◽  
Vera Martins ◽  
Carla Silva
Keyword(s):  
Depressive Symptoms ◽  
Dietary Patterns ◽  
Large Scale ◽  
Randomized Clinical Trials ◽  
Dietary Intervention ◽  
Common Mental Disorder ◽  
Controlled Trial ◽  
Statistical Significance ◽  
Inverse Association ◽  
The Impact

Introduction: The field of nutritional psychiatry is a fast-growing one. Although initially, it focused on the effects of vitamins and micronutrients in mental health, in the last decade, its focus also extended to the dietary patterns. The possibility of a dietary cost-effective intervention in the most common mental disorder, depression, cannot be overlooked due to its potential large-scale impact. Method: A classic review of the literature was conducted, and studies published between 2010 and 2018 focusing on the impact of dietary patterns in depression and depressive symptoms were included. Results: We found 10 studies that matched our criteria. Most studies showed an inverse association between healthy dietary patterns, rich in fruits, vegetables, lean meats, nuts and whole grains, and with low intake of processed and sugary foods, and depression and depressive symptoms throughout an array of age groups, although some authors reported statistical significance only in women. While most studies were of cross-sectional design, making it difficult to infer causality, a randomized controlled trial presented similar results. Discussion: he association between dietary patterns and depression is now well-established, although the exact etiological pathways are still unknown. Dietary intervention, with the implementation of healthier dietary patterns, closer to the traditional ones, can play an important role in the prevention and adjunctive therapy of depression and depressive symptoms. Conclusion: More large-scale randomized clinical trials need to be conducted, in order to confirm the association between high-quality dietary patterns and lower risk of depression and depressive symptoms.

Do we Need Maintenance Chemotherapy in Advanced NSCLC in the Era of Immune and Targeted Therapy?

2019 ◽  
Vol 15 (1) ◽  
pp. 50-55
Author(s):  
Ahmed Nagy ◽  
Omar Abdel Rahman ◽  
Heba Abdullah ◽  
Ahmed Negida
Keyword(s):  
Lung Cancer ◽  
Maintenance Therapy ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Statistical Significance ◽  
Small Cell ◽  
Maintenance Chemotherapy ◽  
Small Cell Lung ◽  
The Impact

Background: Although well established for the effective management of hematologic cancers, maintenance chemotherapy has only been recently incorportated as a treatment paradigm for advanced non–small-cell lung cancer. Maintenance chemotherapy aims to prolong a clinically favorable response state achieved after finishing induction therapy which is usually predefined in number before startng treatment. There are 2 modalities for maintenance therapy; continuation maintenance (involving a non-platinum component which was a part of the induction protocol or a targeted agent) and switch maintenance therapy (utilizing a new agent which was not a part of the induction regimen). Methods: The purpose of this article is to review the role of maintenance therapy in the treatment of advanced Non-Small Cell Lung Cancer (NSCLC) and provide a brief overview about induction chemotherapy in NSCLC to address the basis of maintenance therapy as a treatment option. We will also compare the impact of maintenance chemotherapy with the now evolving role of immunotherapy in NSCLC. Results: There have been 4 maintenance studies to date showing prolonged PFS and OS with statistical significance. However, Three out of the four studies (ECOG4599, JMEN, and PARAMOUNT) did not report tumor molecular analysis. As regard Immunotherapy, current data is in favour of strongly an increasing role for immunotherapy in NSCLC. Conclusion: Maintenance therapy in NSCLC continues to be an important therapeutic line to improve outcome in patients with metastatic and recurrent disease.

scholarly journals Treatment of HIV-associated facial lipoatrophy: impact on infection progression assessed by viral load and CD4 count

2013 ◽  
Vol 88 (4) ◽  
pp. 570-577 ◽  
Author(s):  
Flávia Machado Gonçalves Soares ◽  
Izelda Maria Carvalho Costa
Keyword(s):  
Viral Load ◽  
Disease Progression ◽  
Statistical Significance ◽  
Undetectable Viral Load ◽  
Fat Distribution ◽  
Cd4 Count ◽  
Before And After ◽  
Facial Lipoatrophy ◽  
A Prospective Study ◽  
The Impact

BACKGROUND: HIV/AIDS-Associated Lipodystrophy Syndrome includes changes in body fat distribution, with or without metabolic changes. The loss of fat from the face, called facial lipoatrophy, is one of the most stigmatizing signs of the syndrome.OBJECTIVES:To evaluate the effect of FL treatment using polymethylmethacrylate (PMMA) implants on disease progression, assessed by viral load and CD4 cell count.METHODS: This was a prospective study of 44 patients treated from July 2009 to December 2010. Male and female patients, aged over 18 years, with clinically detectable FL and who had never been treated were included in the study. PMMA implantation was done to fill atrophic areas. Laboratory tests were conducted to measure viral load and CD4 count before and after treatment.RESULTS: Of the 44 patients, 72.72% were male and 27.27% female, mean age of 44.38 years. Before treatment, 82% of patients had undetectable viral load, which increased to 88.6% after treatment, but without statistical significance (p = 0.67). CD4 count before treatment ranged from 209 to 1293, averaging 493.97. After treatment, the average increased to 548.61. The increase in CD4 count after treatment was statistically significant with p = 0.02.CONCLUSION: The treatment of FL with PMMA implants showed a statistically significant increase in CD4 count after treatment, revealing the impact of FL treatment on disease progression. Viral load before and after treatment did not vary significantly.

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