Gabrielle B Rocque1,2, Courtney P Williams2, Kelly M Kenzik1,2,3, Bradford E Jackson4, Andres Azuero5, Karina I Halilova2, Stacey A Ingram2, Maria Pisu1,6, Andres Forero1,2, Smita Bhatia1,3. 1. Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama. 2. Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama. 3. Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama. 4. Center for Outcomes Research, JPS Health Network, Fort Worth, Texas. 5. School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama. 6. Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
Abstract
BACKGROUND: The impact of National Comprehensive Cancer Network (NCCN) treatment guideline concordance on costs, health care utilization, and mortality for patients with breast cancer and secondary metastases is unknown. METHODS: From 2007 to 2013, women with early-stage breast cancer who received treatment for secondary metastases (n = 5651) were evaluated for first recorded systemic therapy concordance with NCCN guidelines within the Surveillance, Epidemiology, and End Results Program-Medicare linked database. Generalized linear and mixed effects models evaluated factors associated with nonconcordance and the relation between concordance status and health care utilization and costs. Mortality risk was estimated with Cox regression. RESULTS: Eighteen percent of the patients received nonconcordant therapy, with the most common being single-agent, human epidermal growth factor receptor 2 (HER2)-targeted therapy (36%), therapy mismatched with the estrogen receptor/HER2 status (11%), unapproved bevacizumab regimens (10%), and adjuvant regimens in a metastatic setting (6%). A younger age, a hormone receptor-negative status, and a HER2-positive status were associated with nonconcordance (P < .05). Nonconcordance was associated with 22% and 21% increased rates of emergency department visits and hospitalizations, respectively, and $1765 higher average monthly Medicare costs. Differences in adjusted mortality risk were noted by the category of nonconcordance; single-agent, HER2-targeted therapy was associated with decreased mortality risk (hazard ratio [HR], 0.66; 95% confidence limit [CL], 0.57-0.76), and increased mortality risk was observed with unapproved bevacizumab use (HR, 1.40; 95% CL, 1.13-1.74). CONCLUSIONS: Most patients (82%) received treatment consistent with NCCN guidelines. Nonconcordant treatment was associated with higher health care utilization and costs, with mortality differences observed by the type of guideline deviation. Consideration of both patient and financial outcomes will be important as health systems increase the emphasis on guideline-based care.
BACKGROUND: The impact of National Comprehensive Cancer Network (NCCN) treatment guideline concordance on costs, health care utilization, and mortality for patients with breast cancer and secondary metastases is unknown. METHODS: From 2007 to 2013, women with early-stage breast cancer who received treatment for secondary metastases (n = 5651) were evaluated for first recorded systemic therapy concordance with NCCN guidelines within the Surveillance, Epidemiology, and End Results Program-Medicare linked database. Generalized linear and mixed effects models evaluated factors associated with nonconcordance and the relation between concordance status and health care utilization and costs. Mortality risk was estimated with Cox regression. RESULTS: Eighteen percent of the patients received nonconcordant therapy, with the most common being single-agent, human epidermal growth factor receptor 2 (HER2)-targeted therapy (36%), therapy mismatched with the estrogen receptor/HER2 status (11%), unapproved bevacizumab regimens (10%), and adjuvant regimens in a metastatic setting (6%). A younger age, a hormone receptor-negative status, and a HER2-positive status were associated with nonconcordance (P < .05). Nonconcordance was associated with 22% and 21% increased rates of emergency department visits and hospitalizations, respectively, and $1765 higher average monthly Medicare costs. Differences in adjusted mortality risk were noted by the category of nonconcordance; single-agent, HER2-targeted therapy was associated with decreased mortality risk (hazard ratio [HR], 0.66; 95% confidence limit [CL], 0.57-0.76), and increased mortality risk was observed with unapproved bevacizumab use (HR, 1.40; 95% CL, 1.13-1.74). CONCLUSIONS: Most patients (82%) received treatment consistent with NCCN guidelines. Nonconcordant treatment was associated with higher health care utilization and costs, with mortality differences observed by the type of guideline deviation. Consideration of both patient and financial outcomes will be important as health systems increase the emphasis on guideline-based care.
Authors: Andrea N Burnett-Hartman; Natalia Udaltsova; Lawrence H Kushi; Christine Neslund-Dudas; Alanna Kulchak Rahm; Pamala A Pawloski; Douglas A Corley; Sarah Knerr; Heather Spencer Feigelson; Jessica Ezzell Hunter; David C Tabano; Mara M Epstein; Stacey A Honda; Monica Ter-Minassian; Julie A Lynch; Christine Y Lu Journal: JCO Clin Cancer Inform Date: 2019-09
Authors: Gabriella C Squeo; Courtney M Lattimore; Nicole L Simone; Greg Suralik; Sunil W Dutta; Michael D Schad; Lucy Su; Bruce Libby; Einsley-Marie Janowski; Shayna L Showalter; Jennifer M Lobo; Timothy N Showalter Journal: Brachytherapy Date: 2022-02-04 Impact factor: 2.441
Authors: Stephanie Stangl; Kirsten Haas; Felizitas A Eichner; Anna Grau; Udo Selig; Timo Ludwig; Tanja Fehm; Tanja Stüber; Asarnusch Rashid; Alexander Kerscher; Ralf Bargou; Silke Hermann; Volker Arndt; Martin Meyer; Manfred Wildner; Hermann Faller; Michael G Schrauder; Michael Weigel; Ulrich Schlembach; Peter U Heuschmann; Achim Wöckel Journal: Pilot Feasibility Stud Date: 2020-02-04
Authors: Gabrielle B Rocque; Aidan Gilbert; Courtney P Williams; Kelly M Kenzik; Arie Nakhmani; Pravinkumar G Kandhare; Smita Bhatia; Mark E Burkard; Andres Azuero Journal: JCO Clin Cancer Inform Date: 2020-06
Authors: Miguel Angel Noy; Benjamin J Rich; Ricardo Llorente; Deukwoo Kwon; Matthew Abramowitz; Brandon Mahal; Eric A Mellon; Nicholas G Zaorsky; Alan Dal Pra Journal: Adv Radiat Oncol Date: 2021-10-29