Previous research demonstrates that payments from third-party payers for infused oncology medicines are higher when care is provided in hospital outpatient departments (HOPDs) compared with physician offices (POs). Some have speculated this is due to differences in patient characteristics and treatment regimens between the two sites of care.
This study employed a novel analytical approach that distinguishes differences in the cost of drugs due to price alone from differences attributable to drug mix and treatment intensity for cancer patients. The analysis was based on 18,195 users of the top 37 infused oncology drugs prescribed to employment-based and commercially insured patients
in 2016.
Key findings:
- Hospital prices for the top 37 infused cancer drugs averaged 86.2 percent more per unit than in physician offices.
- For every drug examined, HOPDs charged more on average with statistically significant relative differences ranging from 128.3 percent (nivolumab) to 428.0 percent (fluorouracil).
- The mean annual reimbursement to providers per user of infused cancer drugs was $13,128 in POs and $21,881 in HOPDs.
- Had hospital unit prices matched physician office prices, holding drug mix and treatment intensity constant, we estimate that commercial insurers would have saved $9,766 per user of these medicines in 2016, a savings of 45 percent.
Read the Study: Employee Benefit Research Institute: Cost Differences for Oncology Medicines Based on Site of Treatment