Bevacizumab Infusion in Office/Clinic versus Outpatient Hospital Setting

San Diego—According to researchers, declining health plan reimbursements for physician-administered chemotherapy may shift the population of oncology patients treated with infused chemotherapy from office/clinic settings to outpatient hospital facilities.

Bevacizumab (BEV), a monoclonal antibody targeting vascular endothelial growth factor, is listed as a treatment option under NCCN compendium for tumor types including metastatic colorectal cancer, advanced nonsquamous non–small-cell lung cancer, metastatic renal cell carcinoma, and recurrent glioblastoma. The agent is typically administered in an office/clinic or outpatient hospital facility under the direct supervision of healthcare personnel.

The researchers recently conducted a longitudinal retrospective analysis to examine differences in treatment patterns and healthcare costs among patients with metastatic colorectal cancer, lung cancer, and other cancers who were treated with BEV in office/clinic settings versus outpatient hospital facilities. They reported results during a poster session at the AMCP meeting in a poster titled Treatment Patterns and Healthcare Costs of Oncology Patients Treated with Bevacizumab in Hospital Outpatient and Office Settings.

The study time period was January 1, 2006, through March 31, 2011. The analysis included medical and pharmacy claims from a large geographically diverse US health plan; eligible participants were commercial and Medicare Advantage plan members ≥18 years of age with both medical and pharmacy claims. Inclusion criteria included ≥2 BEV claims, ≥2 claims with diagnosis codes for specified cancers ≥30 days apart, continuous health plan enrollment ≥6 months pre-and postindex date, no evidence of other primary cancers during the study period, no BEV claims with an ophthalmologist provider, and no BEV during the 6 months prior to the index date. The index date was the earliest BEV date.

The researchers identified 3749 eligible patients; of those, 76.1% (n=2854) were treated in an office/clinic setting and 23.9% (n=895) were treated in an outpatient hospital facility. Patients treated in office/clinic settings were slightly older than those treated in outpatient hospital facilities (59.4 years vs 57.4 years, P<.001). A higher percentage of those treated in offices/clinics resided in the South and a lower percentage resided in the Northeast, compared with those in treated in outpatient hospital facilities. Overall, gender and type of insurance coverage were similar between the 2 cohorts; 42% were men.

Over time, the proportion of patients receiving BEV in outpatient hospital facilities increased. The mean weekly dose of BEV was generally higher in the office/clinic setting; however, the dose administered in the outpatient hospital settings increased over time. Patients treated in office/clinic settings received more infusions of BEV per episode of care than those receiving BEV in an outpatient hospital facility (10.7 vs 7.7) and per month (1.5 vs 1.2) (P<.001). and the duration of therapy was shorter in outpatient hospital settings than in office/clinic settings (196 days vs 211 days; P=.006).

Compared with office/clinic patients, multivariate adjusted per patient per month costs for the outpatient hospital facility patients were 43.1% higher for all patients ($17,511 vs $25,067), 42.4% higher for patients with metastatic colorectal cancer ($16,788 vs $23,866), and 31.1% higher for lung cancer patients ($18,108 vs $23,795).

Unadjusted cost per infusion day were higher in the outpatient hospital setting compared with the office/clinic setting ($16,443 vs $6663; P<.001).

In conclusion, the researchers said, “Further investigation of the shift to the outpatient hospital facility setting and the impact of duration of treatment on clinical outcomes is warranted.”

This study was supported by Genetech.