Price Megan Ellis, Gordon Sarah, Emmitt Caroline, Ndugga Nambi, Kabdiyeva Aigerim, Mull Hillary, Pizer Steven, Garrido Melissa M
VA Boston Medical Center, Boston, Massachusetts, USA.
Boston University School of Public Health, Boston, Massachusetts, USA.
Cancer Med. 2023 Sep;12(17):18110-18119. doi: 10.1002/cam4.6372. Epub 2023 Jul 31.
The MISSION and CHOICE Acts expanded the Veterans Health Administration's (VA) capacity to purchase immunotherapy services for VA patients from community-based providers. Our objective was to identify predictors of community-based immunotherapy treatment, and assess differences in cost and utilization across community treatment settings METHODS: We examined claims for 21,257 patients who started immunotherapy treatment between 2015 and 2020. We assessed growth in VA community-based immunotherapy care, predictors of community-based immunotherapy treatment using multivariable logistic regression based on patients' sociodemographic and clinical characteristics. We compared utilization and costs among those who received community-based immunotherapy services in hospital outpatient departments (HOPDs) versus physician office settings (POs).
The proportion of community-based immunotherapy in the VA increased from 5.3% in 2015 to 32.1% in 2020, with total annual costs of immunotherapy growing from $6.1 million to $187 million. Older, married, and rural patients and those with more comorbidities were more likely than younger, single, or urban patients to be treated in the community. Black patients were more likely to be treated in the VA. Respiratory Cancer was the most common cancer type in both settings. Among community immunotherapy patients, we observed no meaningful differences in the number of units administered, the unit drug costs, or the cost per immunotherapy visit between POs and HOPDs.
Drug costs did not differ widely across HOPDs and POs among VA patients who receive community-based immunotherapy.
《使命与选择法案》扩大了退伍军人健康管理局（VA）从社区医疗机构为退伍军人患者购买免疫治疗服务的能力。我们的目标是确定社区免疫治疗的预测因素，并评估不同社区治疗环境下的成本和使用差异。方法：我们研究了2015年至2020年间开始免疫治疗的21257名患者的索赔记录。我们评估了VA社区免疫治疗的增长情况，使用基于患者社会人口统计学和临床特征的多变量逻辑回归分析社区免疫治疗的预测因素。我们比较了在医院门诊部（HOPD）和医生办公室环境（PO）接受社区免疫治疗服务的患者之间的使用情况和成本。
VA中社区免疫治疗的比例从2015年的5.3%增至2020年的32.1%，免疫治疗的年度总成本从610万美元增至1.87亿美元。年龄较大、已婚、农村患者以及合并症较多的患者比年轻、单身或城市患者更有可能在社区接受治疗。黑人患者更有可能在VA接受治疗。在两种环境中，呼吸道癌都是最常见的癌症类型。在社区免疫治疗患者中，我们观察到PO和HOPD之间在给药单位数量、单位药品成本或每次免疫治疗就诊成本方面没有显著差异。
在接受社区免疫治疗的VA患者中，HOPD和PO之间的药品成本差异不大。
