University of Pennsylvania, 423 Guardian Dr, Blockley 1102, Philadelphia, PA 19104. Email:
Am J Manag Care. 2024 Apr;30(4):186-190. doi: 10.37765/ajmc.2024.89530.
To assess the association between the onset of the COVID-19 pandemic and change in low-value cancer services.
In this retrospective cohort study, we used administrative claims from the HealthCore Integrated Research Environment, a repository of medical and pharmacy data from US health plans representing more than 80 million members, between January 1, 2016, and March 31, 2021.
We used linear probability models to investigate the relation between the onset of the COVID-19 pandemic and 4 guideline-based metrics of low-value cancer care: (1) conventional fractionation radiotherapy instead of hypofractionated radiotherapy for early-stage breast cancer; (2) non-guideline-based antiemetic use for minimal-, low-, or moderate- to high-risk chemotherapies; (3) off-pathway systemic therapy; and (4) aggressive end-of-life care. We identified patients with new diagnoses of breast, colorectal, and/or lung cancer. We excluded members who did not have at least 6 months of continuous insurance coverage and members with prevalent cancers.
Among 117,116 members (median [IQR] age, 60 [53-69] years; 72.4% women), 59,729 (51.0%) had breast cancer, 25,751 (22.0%) had colorectal cancer, and 31,862 (27.2%) had lung cancer. The payer mix was 18.7% Medicare Advantage or Medicare supplemental and 81.2% commercial non-Medicare. Rates of low-value cancer services exhibited minimal changes during the pandemic, as adjusted percentage-point differences were 3.93 (95% CI, 1.50-6.36) for conventional radiotherapy, 0.82 (95% CI, -0.62 to 2.25) for off-pathway systemic therapy, -3.62 (95% CI, -4.97 to -2.27) for non-guideline-based antiemetics, and 2.71 (95% CI, -0.59 to 6.02) for aggressive end-of-life care.
Low-value cancer care remained prevalent throughout the pandemic. Policy makers should consider changes to payment and incentive design to turn the tide against low-value cancer care.
评估 COVID-19 大流行的开始与低价值癌症服务变化之间的关联。
在这项回顾性队列研究中，我们使用了来自 HealthCore 综合研究环境的行政索赔数据，该数据来自代表 8000 多万成员的美国健康计划的医疗和药房数据存储库，时间范围为 2016 年 1 月 1 日至 2021 年 3 月 31 日。
我们使用线性概率模型来研究 COVID-19 大流行开始与 4 种基于指南的低价值癌症护理指标之间的关系：（1）早期乳腺癌的常规分割放疗而非适形分割放疗；（2）低风险、低风险或中高风险化疗的非指南性止吐药物使用；（3）偏离途径的系统治疗；（4）积极的临终关怀。我们确定了新诊断患有乳腺癌、结直肠癌和/或肺癌的患者。我们排除了至少 6 个月连续保险覆盖和有已患癌症成员的成员。
在 117116 名成员中（中位数[IQR]年龄，60[53-69]岁；72.4%为女性），59729 名（51.0%）患有乳腺癌，25751 名（22.0%）患有结直肠癌，31862 名（27.2%）患有肺癌。支付者组合为 18.7%的医疗保险优势或补充医疗保险和 81.2%的商业非医疗保险。低价值癌症服务的比例变化不大，经调整后的百分点差异分别为常规放疗为 3.93（95%CI，1.50-6.36）、偏离途径的系统治疗为 0.82（95%CI，-0.62 至 2.25）、非指南性止吐药物为-3.62（95%CI，-4.97 至-2.27），以及积极的临终关怀为 2.71（95%CI，-0.59 至 6.02）。
低价值癌症护理在整个大流行期间仍然普遍存在。政策制定者应考虑改变支付和激励设计，以扭转低价值癌症护理的局面。
