Abstract
Background: Chemotherapy has been shown to improve both response and survival rates for patients with cancer. As chemotherapy treatments become more costly, these improvements in survival are coming with a substantial price tag. The financial burden of chemotherapy is forcing both patients and health plans to make difficult decisions regarding cancer treatment. Historically, most HMOs have provided comprehensive cancer care with limited, fixed co-payments. However, in recent years, HMOs have begun to implement benefit design packages that increase patient cost-sharing for cancer care services.
Aim: To examine the variation in lung and colorectal cancer patients who receive first choice cancer chemotherapy services as defined by American Society of Clinical Oncologist (ASCO)-derived guidelines, which are currently employed by all Kaiser Permanente (KP) regions. The variation in first choice cancer chemotherapy regimen use by stage, age, gender, and variables capturing differences in benefit design is also examined.
Methods and Study Design: This is a retrospective, observational study of the rates of chemotherapy regimen use for a cohort of HMO cancer patients at two KP regions, Colorado and Georgia. Algorithms were built based on ASCO guidelines, to identify the more than 20 cancer chemotherapy regimens that are based on cancer site (lung vs colorectal), stage, and morphology. These algorithms were mapped to National Drug Codes (NDCs) and patient specific utilization was extracted from legacy pharmacy systems and the Virtual Data Warehouse (VDW) files. A time series for the period 2006–2008 with month-by- month measurement of the proportion colorectal and lung cancer patients who receive first choice cancer chemotherapy services, along with variables denoting variation in patient and tumor characteristics and benefit design, was built. Statistical analyses describing variation were conducted.
Results: Preliminary findings suggest that variation exists within and across the two health plans and by cancer site and stage. Also, variation in the use of first-choice cancer chemotherapy services may be impacted by recently implemented increases in patient costsharing.
Conclusions: Additional analyses are required to further investigate the impact of patient cost-sharing and injectable/infusion coinsurance.
