bluuebunny/crossref_metadata_2025_split huggingface dataset:
Healthcare resource utilization, quality metrics, and costs of bladder cancer within the oncology care model.
Authors: Blakely L. Johnetta , Hepp Zsolt , Fuldeore Rupali , Tomicki Samantha , Hirsch Jared , Dieguez Gabriela , Wirtz Heidi 
Published: September 2021

54 Background: The Oncology Care Model (OCM) incentivizes practices to provide higher quality, lower cost care for Medicare beneficiaries through payment arrangements that include financial and performance accountability for 6-month care episodes. We sought to describe the existing experience with bladder cancer (BC) for OCM practices, in the context of all OCM cancer types, given the dynamic treatment landscape in which new and emerging therapies will impact spending and patient care in this payment model. Objective: To estimate healthcare resource utilization (HRU), OCM quality metrics, and costs for OCM episodes among Medicare beneficiaries with BC. Methods: OCM episodes triggered by receipt of cancer therapy (index event) were identified among Medicare beneficiaries (100% Research Identifiable Files) from 2016-18. Other inclusion criteria were enrollment in Parts A & B for the entire OCM episode (6 months or until death) and 6 months pre-index date, Medicare as primary payer, and ≥1 qualifying Evaluation & Management visit during the episode. A cancer type was assigned to each episode. BC episodes were stratified as low- (defined by receipt of BCG and/or mitomycin without other systemic therapy) or high-risk (receipt of systemic therapy other than BCG or mitomycin) based on OCM definitions. Results: Of the 2.2 million OCM cancer episodes identified among 1 million beneficiaries, 60,099 (̃3%) were BC episodes. Our analytic cohort consisted of 43,621 BC episodes (69% low-risk and 31% high-risk) among 33,497 beneficiaries. Across BC episodes, average patient age was 76.6 years and 77% were male. Relative to low-risk episodes, high-risk episodes included higher metastatic cases (40 vs 2%), and more comorbidity burden (7.4 vs 4.3 Charlson comorbidity score). High-risk episodes had more hospital admissions (0.7 vs 0.2) and intensive care unit use (17 vs 5%), longer length of stay (5.9 vs 4.9 days), and higher rates of surgery (7 vs 1%) and mortality (17 vs 2%). Among OCM quality metrics, high-risk episodes had higher inpatient admissions (42 vs 15%) and emergency department visits (37 vs 20%) relative to low-risk episodes. Average spending per high-risk BC episode was ̃$38,000 (vs $9,204 for low-risk), with ̃$11,000 spent on systemic therapies and ̃$7,000 on inpatient services. Conclusions: High-risk OCM episodes of BC, which included 40% metastatic BC, had higher HRU and costs, and lower quality performance, than low-risk episodes. Novel therapies offer a significant opportunity to optimize BC management and improve quality of care, particularly for high-risk episodes. Further, as < 3% of OCM episodes were attributed to BC, and only one-third of BC episodes were classified as high-risk, controlling expenditure on novel therapies in BC episodes is unlikely to impact overall performance for practices participating in OCM.
Real-world utilization and costs with biosimilar and reference filgrastim in patients with breast cancer receiving myelosuppressive chemotherapy in a community oncology setting from 2015 to 2017.
Authors: Rifkin Robert M. , Herms Lisa , Wentworth Chuck , Vasudevan Anupama , Campbell Kimberley , Li Edward C. 
Published: September 2021

57 Background: Biosimilars have potential to reduce healthcare costs and increase access in the United States, but lack of uptake has contributed to lost savings. Filgrastim-sndz was the first FDA-approved biosimilar, and much can be learned by evaluating its uptake. In February 2016, the US Oncology Network converted to filgrastim-sndz as its short-acting granulocyte colony-stimulating factor (GCSF) of choice for prevention of febrile neutropenia (FN) following myelosuppressive chemotherapy (MCT). To understand utilization and cost patterns, this study analyzes real-world data of GCSFs within a community oncology network during the initial period of conversion to the first biosimilar available in the US. Methods: This descriptive retrospective observational study used electronic health record data for female breast cancer (BC) patients receiving GCSF and MCT at high risk of FN. Patient cohorts were defined by first receipt of either filgrastim or filgrastim-sndz during the 410 days before and after biosimilar conversion. Healthcare resource utilization (HCRU) and costs for GCSF and complete blood counts (CBC) were collected at GCSF initiation through the earliest of 30 days following end of MCT, loss to follow up, death, or data cutoff. Results: 146 patients were identified: 81 (55.5%) filgrastim and 65 (44.5%) filgrastim-sndz. No directional differences existed in baseline characteristics between the cohorts. Higher proportions of filgrastim-sndz patients received dose-dense MCT (33.8% vs 22.2%). Time trends show an initial spike in HCRU and cost for filgrastim-sndz patients after formulary conversion, which subsequently decreased and converged to that of the filgrastim cohort after 12 months. When aggregated, the overall median total administration counts, per patient per month (PPPM) and dosage, were marginally higher for filgrastim-sndz (5 vs 3; 2.9 vs 1.4; 1920 vs 1440 mcg, respectively). Median PPPM costs were higher for filgrastim-sndz ($803 vs $545). Median CBC utilization and costs were higher for filgrastim-sndz (2.8 vs 2.5; $28 vs $23, respectively). Conclusions: This study provides insight into real-world HCRU and cost patterns after formulary conversion to a biosimilar for BC patients receiving MCT and GCSF. As a descriptive study, causal inferences cannot be made and an underlying effect from index chemotherapy cannot be excluded. Convergence of HCRU and costs after 12 months suggests that overall results may be driven by behavior at initial formulary switch. Since filgrastim-sndz was the first US biosimilar approved, the uptake may be indicative of an experience with biosimilar acceptance in general. Future real-world studies of biosimilars must consider inconsistent utilization and practice trends during the time frame directly following formulary conversion.
Safety and feasibility of a nurse-led ambulatory abdominal paracentesis service.
Authors: Lee Kim Hua 
Published: September 2021

63 Background: Ascites is a common complication of cancer. Symptomatic ascites contributes to cancer-related morbidity and is distressing for patients (pts). Therapeutic abdominal paracentesis (TAP) provides symptom relief but requires specialized procedural knowledge and is usually performed in the inpatient setting with several days of hospitalization. Additionally, high hospital bed occupancy during the COVID-19 pandemic prevented timely admission for TAP. An Advanced Practice Nurse (APN)-led ambulatory TAP service was introduced at our center, with the aim of improving access to TAP and reducing hospital bed occupancy. Methods: A multidisciplinary team developed workflows and safety guidelines for TAP to enable right-siting of pts in a cancer day care unit. Pts were scheduled for radiologically guided insertion of abdominal drains in the morning before 10am to allow adequate time for drainage. Pre-procedure clinical examination and safety checks were performed by APNs in the day unit. Following the procedure, abdominal fluid was drained with concurrent administration of 20% IV albumin. Drains were removed by the APN and pts were examined before discharge on the same day. Data for all cancer pts requiring TAP in the day unit and hospital from 1 Jan to 30 Nov 2020 were extracted from the electronic medical record system. The primary outcome was length-of-stay (LOS). The primary safety outcome was adverse events in the day unit. Continuous data were compared using the t-test. Data analysis was done in SPSS version 22. Results: The number of TAPs performed in the day unit and general ward requiring hospitalization were 102 and 133, respectively. There was a significant reduction in average LOS with TAPs performed in the day unit vs. hospitalization (1.48 vs. 5.82 days, p<0.001) (Table). The mean difference was 4.34 (95% confidence interval 3.33 - 5.34) days saved per pt, or a saving of 443 inpatient bed days. The TAP day unit service encountered 10 adverse events (AEs) requiring admission to the ward for continued drainage. AEs were borderline baseline blood pressure, pt frailty and inability to care for an indwelling catheter. There were no infective or bleeding complications. The majority of TAPs (86.8%) were performed in one day, with the remainder over 2-days with the abdominal drain left in-situ and reattendance at the day unit the next day for further drainage. Differences in average length-of-stay with TAP in the hospital vs. day unit. Conclusions: An APN-led ambulatory abdominal paracentesis service is a safe alternative to inpatient paracentesis. Optimal utilization of a day unit enabled reduced LOS for pts with advanced cancer. This reduction in LOS was critical during a pandemic where bed demand was high. This was possible from advanced scheduling and control over the day unit capacity.[Table: see text]
The cost of neuroendocrine tumor patient healthcare: Comparison between advanced economies and emerging and developing economies.
Authors: Gellerman Elyse , Bouvier Catherine , McDonnell Mark , Rodien-Louw Christine , Van Genechten Dirk , Leyden Simone , Dureja Sugandha , Kolarova Teodora 
Published: September 2021

64 Background: The Survey of Challenges in Access to Diagnostics and Treatment for NET Patients (SCAN) measured the delivery of healthcare to neuroendocrine tumor (NET) patients globally. This analysis focused on the cost of NET care, comparing results between Advanced Economies (AE) and Emerging and Developing Economies (EDE). Methods: During Sept-Nov 2019, 2359 NET patients and 436 healthcare professionals (HCPs) from 68 countries across 6 continents completed an online self-report survey, available in 14 languages, disseminated by INCA and its partner organizations. Results: Of all respondents, 88% [2076/2359] were AE NET patients/carers, and 12% [283/2359] were from EDE. HCPs were evenly spread 51% AE [221/436] vs. 49% EDE [215/436]. Almost all patients (94% (2218/2359) were on follow-ups, most commonly on conventional imaging (74%, 1745/2359) and Chromogranin A (ChA) (50%, 1179/2359) both administered with similar frequency every third month. 66% of NET patients globally (1557/2359) declared оut-of-pocket costs related to disease management, significantly higher for EDE (84%, 238/283) vs AE (64%, 1333/2076) p<0.0001 by Chi-square). One third of EDE NET patients (33%, 93/283) spent from 50% to 100% of their annual household income on disease management over the past 12 months. 41% of AE patients (41%, 851/2076) spent up to 10% of the same. State healthcare coverage was claimed by half of AE NET patients (51%, 1064/2076). A national healthcare plan that covered NETs was mentioned by only a third of EDE NET patients (30%, 85/283). According to HCPs, newer, more specialized tools were the least affordable to all NET patients. PRRT was reported as not affordable by 9% of AE HCPs (20/221) and by significantly more – 21% of EDE HCPs (45/215) p<0.0001. Gallium 68 DOTA PET was reported as not affordable by 9% of AE (20/221) and 10% of EDE HCPs (22/215). This monitoring tool was somewhat affordable to patients according to 25% of AE (54/221) and 62% of EDE HCPs (133/215) p<0.0001. According to HCPs, leading specialized services, where available, were somewhat affordable or not at all affordable to NET patients, i.e. a clinical nurse specialized in NETs – not or somewhat affordable ( HCPs AE 16%, 17/108; EDE 37%, 16/43, p<0.0001); a multidisciplinary team (HCPs AE 18%, 34/194; EDE 39%, 68/174, p<0.0001); a NET specialist (HCPs AE 21%, 42/200; EDE 36%, 46/127, p<0.0001), psychological care (HCPs AE 58%, 42/124; EDE 41%, 11/27, p<0.0001). Psychological care was reported to be available by only 13% of EDE HCPs (27/215). Conclusions: More adequate healthcare funding and better and more inclusive healthcare plans to utilize the optimal diagnostic and treatment tools available to improve outcomes and quality of life for NET patients is needed globally. Discrepancies between AE and EDE healthcare accessibility are huge.
Shared decision-making to foster same-day discharge for patients with breast cancer undergoing mastectomy with or without immediate implant-based reconstruction.
Authors: Shelby Melissa , Byrum Stephanie , Billar Julie A , Carnes Michelle , Khan Maryam , Decker Amber , Walthall Gale 
Published: September 2021

65 Background: In 2020, over 324,500 cases of invasive and non-invasive breast cancer were diagnosed, of which 36% underwent mastectomies. The post-operative period for these breast cancer patients can be an especially taxing time, not just because of the physical recovery involved, but the associated financial toxicity a patient may face. Consideration of these factors, and a desire to optimize shared decision-making between providers, nursing staff and patients, prompted the breast team at Banner MD Anderson Cancer Center (BMDACC) to coordinate a system change in post-operative planning for mastectomy patients. Methods: Implementing same day discharge (SDD) as a quality improvement process change for breast cancer patients undergoing mastectomy with or without immediate implant-based reconstruction began in December 2018. A collaborative effort to reduce length of stay while maintaining quality and safety was the goal of the process change. Shared decision making was utilized as the methodology for the quality initiative. Open communication and honest expectations of the postoperative management allowed the patient to be actively involved and helped to remove any preconceived notions about the necessity of post-operative hospitalization. A chart review comprised of retrospective data from 2017-2018 and prospective data from 2019-2020 was performed on SDD and admitted (ADM) patients who underwent mastectomy with or without immediate implant-based reconstruction. The SDD group was contacted to voluntarily answer a survey on their outpatient surgical experience using the Consumer Assessment of Healthcare Providers and Systems Outpatient and Ambulatory Surgery Survey (OAS CAHPS) .Results: The utilization of shared decision-making revealed an increase in SDD with no increase in readmission or adverse events (Table). The OAS CAHPS survey was completed by78% SDD; findings revealed 95% of patients responded positively to all questions. Conclusions: For patients undergoing mastectomy, with or without immediate implant-based reconstruction, SDD is a safe and value-based initiative that has been adopted as standard of care at BMDACC. [Table: see text]
Evaluation of drug cost avoidance resulting from conduct of cancer clinical trials in a community-based oncology practice.
Authors: Sanyal Amit , Heun James M. , Glynn Brittany , Porter Ryan , Wellner Daniel 
Published: September 2021

66 Background: Aim: To prospectively evaluate cost avoidance during routine conduct of cancer clinical trials in a community based integrated delivery network (IDN) consisting of a health services provider group, a health insurance plan and a hospital system. Only 2%–7% of adult cancer patients participate in clinical trials nationwide [1]. Inadequate funding and concerns about financial viability have been identified as factors that impede clinical trial accrual in the community oncology setting. ‘Cost-avoidance’, defined as dollars that would have been spent to purchase medications but were not spent because of study-related interventions [3] has been proposed as one mechanism to overcome this. Methods: Anti-cancer and hematology drugs provided by intergroup as well as pharmaceutical industry-based trial sponsors to patients enrolled in oncology clinical research were tabulated. Analysis of cost avoidance was restricted to patients covered by the IDNs health plan. Additionally, drugs provided by the trial sponsor were included in the analysis only if they represented a normal standard of care for the disease state. Cost avoidance was defined as the net ingredient cost of the drugs that would have been spent by the health plan for patient care if drugs provided by trial sponsors were not available. Results: Between January 2020 and April 2021, 25 patients covered by the IDN were recruited into clinical trials. Cost savings resulted from 7 targeted and immuno-oncology medications. Net cost avoidance in 2020 was $1,229,798 while that in 2021 till date has been $892,783. The realized cost savings has allowed recruitment of additional clinical research staff as well as expansion of clinical research to rural regional sites served by the IDN. Conclusions: Anticancer drugs provided free of charge by clinical trial sponsors render significant cost savings, ensuring viability and even expansion of oncology clinical research in community based IDNs. References: National Health Expenditure Data. 2018, U.S. Centers for Medicare & Medicaid Services: Baltimore, MD 21244. McDonagh MS, M.S., Naden E., Costs and savings of investigational drug services. American Journal of Health-Systems Pharmacy, 2000. 57: p. 40-43.[Table: see text]
Impact of a central review oncology clinical pharmacist in a community oncology practice.
Authors: Kula Julianna , Hough Shannon , Howell Josh 
Published: September 2021

68 Background: The impact and role of a clinical pharmacist in a community oncology setting is not well-described in the literature. The US Oncology Network recently implemented a central clinical pharmacist review program (ClinReview) to offer oncology remote clinical pharmacist services to practices. Methods: An oncology-trained clinical pharmacist electronically reviewed recently placed or modified chemotherapy regimen orders within a community oncology practice. The ClinReview pharmacist identified opportunities to modify ordered therapy based on clinical components, waste reduction, or financial stewardship. Recommendations were discussed with the treating oncologist at the practice or modified if permitted by approved practice policy. The pharmacist was appointed at 0.5 full-time equivalents (FTE). Financial and workload metrics were tracked to monitor the impact of the pharmacist work. Results: In 10 weeks, 388 reviews were documented and 191 (49.2%) required a modification by the pharmacist. Recommended modifications included dose rounding (n=90, 47%), a clinical change (n=72, 38%), or product substitution (n=29, 15%). The most common clinical changes included modifications to supportive care (n=32, 44%), recommendations for additional monitoring (n=19, 26%), or modifications to anti-cancer medication dose or frequency (n=18, 25%). The financial impact of the pharmacist resulted in margin improvements totaling $106,043 and a $462,305 reduction in the total cost of care in medication expenses (Table). The expense of the pharmacist during this period was $18,095. The return on investment for the pharmacist compared to margin improvement was 590%. Conclusions: An oncology clinical pharmacist is a cost-effective and valuable member of the care team in community oncology practice. The pharmacist identified opportunities to improve medication safety, regimen optimization, and demonstrated significant financial impact for the practice, payers, and patients.[Table: see text]
Factors associated with target price status within the oncology care model population.
Authors: Molaei Matthew , Walsh Karen , Keith Scott W. , Csik Valerie Pracilio , Leader Amy , Maio Vittorio 
Published: September 2021

72 Background: The Oncology Care Model (OCM) is an alternative payment model put forth by the Centers for Medicare and Medicaid Services (CMS), which aims to improve quality of care for cancer beneficiaries, while reducing cost. One of the strategies implemented by CMS to achieve this goal was the development of an episode target price (TP), which uses historical data and episode specific adjusters to calculate a total cost of care goal for each episode. The goal of this analysis was to better understand how CMS risk adjustments could account for episode characteristics, as well as how these characteristics affect likelihood of meeting target price. Methods: OCM performance claims data were abstracted retrospectively from performance periods (PP) 1-6 (episodes initiated from 7/1/2016 – 12/31/2019), in which each episode captured 6 months of care. EHR data was linked to identify cancer staging for OCM Beneficiaries. Any OCM beneficiary with at least one episode in PP 1-6 was included. To assess odds of meeting TP, a logistic regression model with a generalized estimating equation was used to account for patients who contributed multiple episodes. Specific factors evaluated for their association with meeting TP included patient’s age and sex, cancer stage, cancer type, cancer related surgery, clinical trial participation, hospice status, inpatient admissions, observational stays, Medicare part B drug use and radiation therapy. Results: 4,612 episodes were included in analysis, which translated to 2,459 patients, who had an average age of 72 years old and were majority female (50.5%). 2,790 (60.5%) of the episodes met the TP set by OCM. When controlling for covariates, radiation treatment (OR = 1.75, 95%CI: 1.39-2.23), stage 2 compared to stage 4 cancers (OR = 1.86, 95%CI: 1.23-2.80), colorectal cancers (OR = 1.75, 95%CI: 1.11-2.77) and melanomas (OR = 4.35, 95%CI: 2.18-8.67) were significantly associated with increased odds of meeting TP. Novel therapies (OR = 0.19, 95%CI: 0.14-0.26), inpatient admissions (OR = 0.27, 95%CI: 0.22-0.33), observational stays (OR = 0.66, 95%CI: 0.51-0.87) and part B drug use (OR = 0.75, 95%CI: 0.60-0.93) were associated with significantly reduced odds of meeting TP. Conclusions: Our analysis suggests that radiation treatment, as well as selected cancer stage and types may contribute to increased likelihood of meeting TP, which may point to potential areas of cost savings. Conversely, specific resource utilizations such as novel therapy use, inpatient admissions, observational stays, and Medicare part B drug use may decrease the odds of meeting TP, despite being adjusted for in the OCM model. While CMS has recognized that late stage cancers require a more sensitive TP with the metastatic adjustment, other adjustments should also be considered to adequately account for episode characteristics. External validation at other OCM-participating practices is needed to corroborate these results.