Cancer Surgery Expenses and Care Utilization at National Cancer Institute Centers vs Community Hospitals

Study findings show higher insurer spending for a surgical episode at National Cancer Institute (NCI) centers than in community hospitals among patients with private insurance, without differences in care utilization (JAMA Netw Open. 2021;4[8]:e2119764. doi:10.1001/jamanetworkopen.2021.19764).

“With rising expenditures on cancer care outpacing other sectors of the US health system, national attention has focused on insurer spending, particularly for patients with private insurance, for whom price transparency has historically been lacking,” explained Samuel U. Takvorian, MD, MSHP, Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, and colleagues.

“The type of hospital at which cancer care is delivered may be an important factor associated with insurer spending for patients with private insurance,” they continued.

This study aimed to examine differences in insurer spending and care utilization for patients with private insurance undergoing cancer surgery at NCI centers vs community hospitals.

Adult patients with an incident diagnosis of breast, colon, or lung cancer who underwent cancer-related surgery from 2011 to 2014 were included in the study. Generalized linear mixed-effects models, adjusting for patient, hospital, and region characteristics, were used to examine mean risk-adjusted spending and utilization outcomes for each hospital type.

Data were collected from the Health Care Cost Institute’s national multipayer commercial claims data set. This data set includes claims paid by 3 of the 5 largest commercial health insurers in the United States (ie, Aetna, Humana, and UnitedHealthcare). Data analyses were conducted from February 2018 to February 2019.

The main spending outcomes measures were surgery-specific insurer prices paid and 90-day postdischarge payments. Utilization outcomes measures were length of stay (LOS), emergency department (ED) use, and hospital readmission within 90-days postdischarge.

A total of 66,878 patients with incident breast (n = 35,788; 53.5%), colon (n = 21,378; 47.2%), or lung (n = 9712; 14.5%) cancer undergoing cancer surgery at 2995 hospitals were included in the study. Overall, 5522 (8.3%) patients were treated at NCI centers, 10,917 (16.3%) at non-NCI academic hospitals, and 50,439 (75.4%) at community hospitals.

Findings show treatment at NCI centers was associated with higher surgery-specific insurer prices paid ($18,526; 95% CI, $16,650-$20,403) compared with community hospitals ($14,772; 95% CI, $14,339-$15,204). Treatment at NCI centers was also associated with higher 90-day discharge payments ($47,035; 95% CI, $43,289-$50,781) vs community hospitals ($41,291; 95% CI, $40,350-$42,231).

No significant differences in LOS, ED use, or hospital readmission within 90-days postdischarge were reported.

“In this cross-sectional study, surgery at NCI centers vs community hospitals was associated with higher insurer spending for a surgical episode without differences in care utilization among patients with private insurance undergoing cancer surgery,” concluded Dr Takvorian and colleagues.

“A better understanding of the factors associated with prices and spending at NCI cancer centers is needed,” they added.—Janelle Bradley