Immunotherapy costs drive Medicare spending increase for end-of-life cancer care
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Key takeaways:
- Medicare outpatient expenses for end-of-life care increased 12% between 2016 and 2019.
- Greater use of immunotherapy drugs accounted for 84% of the overall increase.
Oncology drug costs overall, and immunotherapy costs specifically, drove Medicare spending increases for outpatient end-of-life cancer care, according to research in International Journal of Radiation Oncology, Biology, Physics.
Expanding use of biosimilars may be an effective approach to moderate cancer drug costs, researchers concluded.
Rationale and methodology
“As Medicare struggles to manage its expenditures, we wanted to study cancer care costs at the end of life,” Constantine Mantz, MD, FASTRO, radiation oncologist and chief policy officer for GenesisCare, told Healio. “Both cancer care and end-of-life care for all patients are each large and well-studied expenses for the Medicare program, but very little attention has been given to recent cost trends for patients with cancer during the last 6 months of life. This study was an effort to help identify possible opportunities for optimizing the value of care.”
The descriptive retrospective cohort study included 84,744 Medicare beneficiaries with a cancer diagnosis who died between 2016 and 2019.
Researchers analyzed Medicare Standard Analytic Files for all paid claims for beneficiaries during the last 6 months of life, and calculated provider payments according to service/supply category and year of death. They used Pearson’s chi-square test to compare service and supply utilization and costs between patient groups.
Findings
Results showed a 12% increase (from $14,487 to $16,227) from 2016 to 2019 in average total Medicare Part B payments per treated beneficiary during the last 6 months of life.
Researchers observed the greatest absolute cost increase of 34.2% (from $7,030 to $9,436) in the medical oncology service category. Within that category, drug use shifted from less costly chemotherapy and hormone therapy agents to more expensive immunotherapy agents, which accounted for 84% of the increase during the period in total Part B payments for all categories, researchers wrote.
“We observed modest cost increases of less than 10% during the period for almost all service and supply categories, while decreases were observed for radiation oncology and anesthesia/pain management services,” Mantz said.
Implications
The findings may help support initiatives to better optimize the value of cancer care at the end of life, according to Mantz.
“We will update our cost trends as we obtain more recent Medicare data and model potential cost-saving scenarios such as using biosimilars and earlier transitions to hospice care,” he told Healio.
Even though immunotherapies are increasingly used, Mantz said oncologists should be supportive if the tradeoff for side effects and higher costs is improved patient survival and quality of life.
“We can argue about what the price may be, but I don’t think we can argue about the net benefit provided to the patient in terms of their overall health,” he said. “What can be problematic is the continued use of a treatment that imposes meaningful risk [for] side effects and cost burden for patients approaching the end of life. We must get better at recognizing who those patients are, and when appropriate, transitioning them to less risky, less expensive therapies.”
For more information:
Constantine Mantz, MD, FASTRO, can be reached at constantine.mantz@usa.genesiscare.com.
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