Research on the Economics of Cancer-Related Health Care: An Overview of the Review Literature

Enhancing Cancer Economic Data Resources: The Interagency Consortium to Promote Health Economics Research on Cancer (HEROiC)

BACKGROUND

Cancer diagnosis and treatment can substantially affect health and financial outcomes for patients and families. Research in health care delivery across the cancer control continuum includes diverse activities led by multiple government and private sector organizations. Assessing the economic drivers and influencing factors associated with costs across this continuum is challenging as organizations leading research efforts often do not have forums to share data, develop linkages, and explore collaborative opportunities.

OBJECTIVE

To describe the objectives, activities, and goals of the Interagency Consortium to Promote Health Economics Research on Cancer (HEROiC) to strengthen data resources and capacity for collaborative patient-focused cancer health economics research.

MAIN ARGUMENT

HEROiC's goals include assessing the economic burden of cancer; examining the effects of policies, health care setting/system factors, and health service delivery approaches across the cancer control continuum; and enhancing collaborations among researchers and organizations.

CONCLUSIONS

Data resources to study economic outcomes associated with cancer control are highly fragmented; HEROIC provides a forum to collaboratively develop, enhance, and utilize data resources and infrastructure for patient-centered cancer health economics research. This includes sharing data resources, developing linkages, identifying new data collection venues, and creating and supporting the dissemination of evidence-based information to diverse stakeholders. These efforts provide critical information to address the economic burden of cancer.

RELEVANCE TO THE SPECIAL ISSUE

Cancer diagnosis and treatment affect patient health and financial outcomes. This commentary describes how HEROiC will enhance research data infrastructure and collaborations to support patient-centered research with the goal of reducing the economic burden of cancer.

Chemotherapy Treatment Costs and Clinical Outcomes of Colon Cancer in the U.S. Military Health System's Direct and Private Sector Care Settings

INTRODUCTION

Identifying low-value cancer care may be an important step in containing costs associated with treatment. Low-value care occurs when the medical services, tests, or treatments rendered do not result in clinical benefit. These may be impacted by care setting and patients' access to care and health insurance. We aimed to study chemotherapy treatment and the cost paid by the Department of Defense (DoD) for treatment in relation to clinical outcomes among patients with colon cancer treated within the U.S. Military Health System's direct and private sector care settings to better understand the value of cancer care.

MATERIALS AND METHODS

A cohort of patients aged 18 to 64 years with primary colon cancer diagnosed between January 1, 1999, and December 31, 2014, were identified in the Military Cancer Epidemiology database. Multivariable time-dependent Cox proportional hazards regression models were used to assess the relationship between chemotherapy treatment and the cost paid by the DoD (in quartiles, Q) and the outcomes of cancer progression, cancer recurrence, and all-cause death modeled as adjusted hazard ratios (aHRs) and 95% confidence intervals (95% CIs). The Military Cancer Epidemiology data were approved for research by the Uniformed Services University of the Health Sciences' Institutional Review Board.

RESULTS

The study included 673 patients using direct care and 431 patients using private sector care. The median per patient chemotherapy costs in direct care ($111,202) were lower than in private sector care ($350,283). In direct care, higher chemotherapy costs were associated with an increased risk of any outcome but not with all-cause death. In private sector care, higher chemotherapy costs were associated with a higher risk of any outcome and with all-cause death (aHR, 2.67; 95% CI, 1.20-5.92 for Q4 vs. Q1).

CONCLUSIONS

The findings in the private sector may indicate low-value care in terms of the cost paid by the DoD for chemotherapy treatment and achieving desirable survival outcomes for patients with colon cancer in civilian health care. Comprehensive evaluations of value-based care among patients treated for other tumor types may be warranted.

Financial Toxicity Order Set: Implementing a Simple Intervention to Better Connect Patients With Resources

PURPOSE

Financial toxicity of cancer treatment is well described in the literature, including characterizations of its risk factors, manifestations, and consequences. There is, however, limited research on interventions, particularly those at the hospital level, to address the issue.

METHODS

From March 1, 2019, to February 28, 2022, a multidisciplinary team conducted a three-cycle Plan-Do-Study-Act (PDSA) process to develop, test, and implement an electronic medical record (EMR) order set to directly refer patients to a hospital-based financial assistance program. The cycles included an assessment of the efficacy of our current practice in connecting patients experiencing financial hardship with assistance, the development and piloting of the EMR referral order, and the broad implementation of the order set across our institution.

RESULTS

In PDSA cycle 1, we found that approximately 25% of patients at our institution experienced some form of financial hardship, but most patients were not connected to available resources because of our referral mechanism. In PDSA cycle 2, the pilot referral order set was deemed feasible and received positive feedback. Over the 12-month study period (March 1, 2021-February 28, 2022) of PDSA cycle 3, 718 orders were placed for 670 unique patients across interdisciplinary providers from 55 treatment areas. These referrals resulted in at least $850,000 in US dollars (USD) in financial aid in 38 patients (mean = $22,368 USD).

CONCLUSION

The findings from our three-cycle PDSA quality improvement project demonstrate the feasibility and efficacy of interdisciplinary efforts to develop a hospital-level financial toxicity intervention. A simple referral mechanism can empower providers to connect patients in need with available resources.

Current State of Funded National Cancer Institute Grants That Include Economic Analyses

BACKGROUND

Health economics research is an integral part of the transdisciplinary research supported by the National Cancer Institute (NCI). To better understand NCI activities in this area, we conducted a portfolio analysis of funded NCI grants including health economics research.

METHODS

We examined all competitive grants funded by NCI from fiscal years 2015 to 2020 that included economic analyses or outcomes. Grant titles, abstracts, and specific aims were independently reviewed by 2 study team members; content of included grants was then coded for analysis.

RESULTS

A total 212 grants were identified from searches; 146 of these included economic analyses and were included in the portfolio analysis. These 146 grants represent approximately 0.9% of all NCI competitively funded grants awarded 2015-2020. Of these grants, 100 were R01 awards, representing approximately 2.4% of all NCI R01 grants funded 2015-2020. The most common study type was interventional randomized controlled-trial, followed by simulation or model. Screening and prevention were the most frequent grant cancer continuum topic; survivorship was included in only 16 grants (11.0%). Cost-effectiveness analysis was the most frequently listed economic outcome (97 grants, 66.4%), whereas policy impact (20 grants, 13.7%) and financial hardship (15 grants, 10.3%) were less-frequently included economic outcomes. However, economic outcomes differed by cancer control continuum topic, with financial hardship being included in a greater proportion of treatment and survivorship grants.

CONCLUSIONS

Although relatively small, the NCI portfolio of funded grants including economic analyses is diverse, covering a range of cancer types, methods, and economic outcomes, and increasing over time.