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Therapeutic Interchange Reduces Cost While Maintaining Quality of Care in the US Oncology Care Model
Hope Ives (McKesson, Denver, CO; US Oncology Network, Dallas, TX) and colleagues defined the Oncology Care Model (OCM) as, “a Medicare value-based care program, that rewards practices for decreasing the total cost of care (TCOC) compared to a benchmark price,” in their presentation “Therapeutic interchange: The cornerstone of cost effectiveness in the Oncology Care Model performance for the U.S. Oncology Network” at the 2022 ASCO Quality Care Symposium.
In the Oncology Care Model, patients who were enrolled were evaluated during the 1-year Performance Period (PP) which occurred in 6-month episodes. According to Ives and colleagues, “therapeutic interchange (TIC) with lower-cost generic/biosimilar/therapeutic alternative medications offer significant cost savings to payers and patients while maintaining equivalent quality of care.” This study focused on the interchange of high-cost medications to lower cost medication alternatives (LCA) in The US Oncology Network during OCM PP 7 (PP7), 8 (PP8), and 9 (PP9).
During PP 7 through 9, eight TIC opportunities were evaluated which included changing therapy from reference products to biosimilars (bevacizumab, trastuzumab, rituximab, pegfilgrastim, filgrastim), from brand to generics (abiraterone, imatinib, fosaprepitant), and from high cost to LCA (aprepitant to fosaprepitant, denosumab to zoledronic acid). By comparing LCA cost vs estimated cost, Ives and colleagues were able to measure the TCOC impact.
The cumulative savings from TIC were $26.0 million in PP7, $32.3 million in PP8, and $32.9 million in PP9. TIC to biosimilars contributed $6.6 million in PP8 and $12.2 million in PP9 of the cumulative savings. TIC reduced TCOC by 2.78% in PP7, 4.13% in PP8, and 5.25% in PP9 within the OCM.
Ives and colleagues concluded that “TIC to biosimilars, generics and clinically appropriate LCA is an effective way to reduce TCOC while maintaining the quality of care in the OCM.” Significant reductions in TCOC can occur with small shifts toward LCA, which is critical to achieving the goal of bending the cost curve in oncology care.
Source
Ives H, Feinberg E, Indurlal P, et al. Therapeutic interchange: The cornerstone of cost effectiveness in the Oncology Care Model performance for the U.S. Oncology Network. Presented at: the 2022 ASCO Quality Care Symposium; September 30-October 1, 2022; Chicago, IL, and virtual; Abstract 5.
