Tag Archives: Bruce Pyenson

Comparing episode of cancer care costs in different settings: An actuarial analysis of patients receiving chemotherapy

Cancer patients receiving active treatment with chemotherapy incur four times the costs of cancer patients not receiving chemotherapy. The cost of patients receiving chemotherapy has been reported to vary by site of service, with higher costs when treatment is delivered in a hospital outpatient setting (HOP) versus a physician office visit (POV). Recent reports indicate an increasing portion of chemotherapy is being delivered in HOP settings and less in POV settings, which can increase costs for payors and/or employers.

This study provides new information by examining Truven MarketScan® commercial claims data (index years 2009 and 2010) to calculate the episode cost of chemotherapy delivered in the HOP versus POV settings for specific disease states. HOP costs were 28% to 53% higher than the POV costs depending on the cancer and adjuvant or metastatic stage. In particular, we noted significantly higher per-episode cost for chemotherapy drugs, radiation oncology, imaging (CT, MRI, and PET scans) and laboratory services in the HOP setting.

This report was commissioned by Genentech.

Lung cancer screening reading list

Milliman’s actuarial research has played a key role in the establishment of an evidence-based case for lung cancer screening. The announcement by the U.S. Preventive Services Task Force (USPSTF) stating it will now recommend lung cancer screening for certain high-risk populations follows a series of actuarial studies that helped make the value case for such screenings.

The following reading list highlights the actuarial research and also provides links to other lung cancer-related content.

An actuarial approach to comparing early stage and late stage lung cancer mortality and survival (subscription required)
This actuarial analysis of lung cancer mortality published in Population Health Management provides evidence that early detection of lung cancer generates genuine mortality reductions not associated with lead time bias, and therefore could reduce late stage deaths by over 70,000 people in the United States each year.

An actuarial analysis shows that offering lung cancer screening as an insurance benefit would save lives at relatively low cost
Using actuarial models, this study published in Health Affairs estimates the costs and benefits of annual lung cancer screening if offered as a commercial insurance benefit in the high-risk U.S. population, ages 50 to 64.

Improved lung cancer screening could lead to earlier detection
In this interview, the authors and sponsors of the first actuarial analysis of lung cancer mortality discuss the broader implications their research may have in the effort to reduce deaths associated with the disease.

An actuarial analysis of lung cancer screening
This blog post highlights Bruce Pyenson’s presentation on lung cancer screening at Health Affairs’ “Value in Cancer Care” briefing in 2012.

Healthcare and MPL costs related to preventable adverse drug events

Harmful medication errors, or preventable adverse drug events (ADEs), are prominent quality and cost issues in healthcare. Injectable medications are important therapeutic agents, but they are associated with a greater potential for serious harm than oral medications. The economic burden of preventable ADEs associated with inpatient injectable medications and the associated medical professional liability (MPL) costs had not been previously described in the literature.

This study finds that the healthcare and MPL costs associated with preventable ADEs are substantial. The authors estimate that inpatient preventable ADEs associated with injectable medications increase annual U.S. payor costs by $2.7 billion up to $5.1 billion, while MPL costs associated with injectable medications total $300 million to $610 million annually.

The study was published in the December 2012 issue of American Health & Drug Benefits.

Chemotherapy parity law extends coverage for oral treatments

Nebraska recently enacted a chemotherapy parity law requiring insurance companies to insure oral chemotherapy the same as intravenous cancer treatments. This article in the Lincoln Journal Star cites a 2010 study conducted by Kate Fitch, Kosuke Iwasaki, and Bruce Pyenson on the cost-sharing of oral and intravenous cancer drugs.

Here is an excerpt from the article:

Sen. Jeremy Nordquist of Omaha, who spearheaded the legislation in Nebraska, said the lack of parity in coverage between intravenous and oral chemotherapy medications is a growing problem. Some cancer treatments cost $5,000 to $10,000 a month, and some patients are being forced to pay high out-of-pocket costs for chemotherapy taken orally.

“This … will make life-saving cancer treatments more accessible and affordable for cancer patients,” he said. “The decision about the best course of treatment, whether it be IV chemo or chemo in a pill form, will be made between patients and their doctor, not dictated by their insurance company.”

Nordquist said research shows that when confronted with the reality of high out-of-pocket expenses, many cancer patients forgo expensive therapy and discontinue treatment, in part because they do not want to saddle their families with unmanageable debt.

And because oncologists know how expensive oral medications can be, he said, they often do not prescribe them — even when they think that would be the best option.

The actuarial and benefits consulting firm Milliman Inc. did a study in 2010 that estimated that requiring similar coverage for oral chemotherapy would cost less than $6 a year per person in most insurance plans.

To read the entire Milliman study, click here.

Assessing the use of anticoagulant drugs in the Medicare population

Atrial fibrillation is the most common form of cardiac arrhythmia, better known as an irregular heartbeat. The disorder has significant health and cost concerns for the Medicare population because of its association with an increased risk for stroke and all-cause mortality.

A study published in the May/June issue of American Health & Drug Benefits by Milliman’s Kate Fitch, Jonah Broulette, Bruce Pyenson, and Kosuke Iwasaki used Medicare Part D claims data to assess the use of the anticoagulant drug warfarin in the Medicare population.

Here is an excerpt highlighting key points from the study entitled “Utilization of Anticoagulation Therapy in Medicare Patients with Nonvalvular Atrial Fibrillation:”

• Patients with atrial fibrillation (AF) are at a significant, 5-fold increased risk for stroke and all cause mortality compared with those without AF.

• Oral anticoagulation therapy is recommended by national guidelines as the cornerstone for stroke prevention in patients with AF.

• Warfarin significantly reduces the risk for ischemic stroke; newer anticoagulant agents have shown even greater reduction of stroke risk compared to warfarin.

• Although AF risk increases with age, this present study shows that anticoagulation therapy is underutilized in Medicare beneficiaries who have nonvalvular AF (NVAF), resulting in an increase in ischemic strokes.

• These findings suggest the need to follow guideline-based anticoagulation recommendations in patients with NVAF to prevent strokes and the associated excess in healthcare costs, reduced quality of life, and even death.

• These findings also raise the need to investigate provider compliance with clinical guidelines regarding oral anticoagulation therapy for stroke prevention in older patients (aged >65 years) with NVAF.

A copy of the entire study can be read here.

Winghan Jacqueline Kwong, of Daiichi Sankyo Inc. also co-authored the study.

An actuarial analysis of lung cancer screening

Bruce Pyenson presented his study on lung cancer screening at Health Affair’s “Value in Cancer Care” briefing on April 12 in Washington DC. Watch his presentation at HealthAffairs.org – scroll down to “The Case For Lung Cancer Screening of High-Risk Patients & Improving Payment And Delivery Of Cancer Care.”

Also, here is the study’s abstract:
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