As payers continue to look for the best ways to cover cancer treatment, a new study is lending support to the argument for moving away from hospital inpatient settings.
The Cleveland Clinic is making a value-based practice change after a study at the health system comparing inpatient and outpatient treatment for head and neck cancers found higher costs in inpatient regimens without benefits in outcomes.
In a randomized prospective study, the Cleveland Clinic tracked patients with squamous cell head and neck cancers who were given the same chemoradiation regimens either at outpatient facilities or at hospital inpatient centers.
After two years of treatment, there were no differences in outcomes for patients, according to the study, but net revenue and total cost differed a fair amount between the two settings.
The inpatient group had net revenue $19,300 higher than the outpatient group, along with $18,600 in higher total costs per patient, suggesting that the outpatient regimen is "the better value-based therapy," said John Greskovich, MD, a radiation oncologist in Cleveland Clinic and lead author of the study.
The higher inpatient treatment costs largely came from planned and unplanned hospitalizations, but it doesn't seem those services provided any additional benefit to patients, said Greskovich.
"When we looked at outcomes at two years, they were statistically the same in the two arms of the study," he said in a media release. "There was no statistical difference between the two treatments with respect to overall survival, relapse-free survival, locoregional or distant control."
The study is something of a research-first, as a randomized prospective trial comparing outcomes for two treatment settings in head and neck cancer.
Greskovich said the study also "exemplifies value-based decision-making centered on three factors: clinical benefit to the patient, typically measured by disease-free survival; toxicity of therapy, measured by acute and late toxicities and quality of life; and cost of therapy--cost to the patient and cost to society, including payer costs."
Based on the findings, the Cleveland Clinic ended up phasing out the use of inpatient treatment regimens for head and neck cancer patients over the course of three years, concluding in 2013.