While many factors can influence cost in head and neck cancer, a simple bundled payments model for the disease can be developed based solely on treatment types, researchers reported.
The number of treatment modalities was the biggest driver of cost in an analysis of 150 head and neck cancer patients. Whether those patients needed single-modality, bimodality, or trimodality treatment was in turn driven by the stage of the disease; by contrast, patient factors had no significant cost impacts, the investigators found.
Based on those findings, they developed a three-tiered cost model in which surgery or radiation was the least costly, chemoradiation or surgery plus radiation was next, and surgery plus chemoradiation was associated with the highest cost.
Basing bundled payments on treatment modality is a “simple but clinically robust model” for payment selection in head and neck cancer patients, wrote senior author Matthew C. Ward, MD, of the Levine Cancer Institute at Atrium Health in Charlotte, N.C., and coauthors.
“A tiered system driven by treatment complexity will aid providers who seek to stratify financial risk in a simple and meaningful manner,” Dr. Ward and colleagues wrote in the Journal of Oncology Practice.
As cancer costs rise, bundled payment models seek to “incentivize value and reduce administrative waste” with a single payment per episode of care, shared by all providers contributing to that episode, they wrote. However, there have been few cancer-specific bundled payment programs described to date.
The tiered approach was based on an analysis of 150 patients with stage 0 to IVB head and neck cancer, excluding those with recurrent or metastatic disease and those treated with palliative intent. Most (58%) had stage IVA disease and the oropharynx was the tumor subsite in 48%.
Direct costs could not be published because of institutional policy, according to Dr. Ward and coauthors, who instead reported overall costs of treatment as relative median costs, or the ratio of the cost of a specific treatment versus the cost of surgery alone.
Specifically, surgery plus chemoradiation was the most costly versus surgery alone, with a relative median cost of 3.13 (P less than .001), followed by chemoradiation at 2.18 (P less than .001) surgery and radiation at 1.98 (P less than .001), and radiation alone at 1.66 (P = .013).
The treatment modalities used were driven by groups of stages, the investigators wrote. Compared with stages 0 to I, stages II to IVA were 33% more expensive, while stage IVB was 60% more expensive. Patient factors such as age, smoking, or comorbidities were not associated with cost.
Previous reported studies of cancer-specific bundled payment models have shown decreased costs and favorable outcomes, according to the researchers. Among those is an University of Texas MD Anderson Center report showing that a four-tiered model, based on treatments received and stratified by comorbidities, was feasible in a 1-year pilot study.
The current report validates those previous findings, with some differences, Dr. Ward and coauthors wrote. In particular, the three-tiered model was not stratified by Charlson comorbidity index, which did not correlate with cost in the present analysis, and it included less common disease sites than in the MD Anderson model.
“We felt it important to be inclusive of all patients seen by our multidisciplinary head and neck cancer team to keep the proposed bundled payments model as practical and simple as possible,” they wrote.
Dr. Ward reported a consulting or advisory role with AstraZeneca. Study coauthors provided disclosures related to Blue Earth Diagnostics, Merck, Varian Medical Systems, UpToDate, Gerson Lehrman Group, Osler, AlignRT, Chrysalis Biotherapeutics, and others.
SOURCE: Tom MC et al. J Oncol Pract. 2019 Apr 22. doi: 10.1200/JOP.18.00665.