Pay-for-Performance Increases Prescribing of Evidence-Based Cancer Drugs, Does Not Yield Cost Savings

Pay-for-performance programs may be effective in increasing evidence-based cancer drug prescribing, but may not yield cost savings, according to a study published in the Journal of Clinical Oncology.¹

This is the first study to demonstrate how a national insurer’s voluntary pay-for-performance program can successfully alter prescribing patterns among oncologists in order to provide higher-quality cancer care.

“We know that prescribing evidence-based cancer drugs is high-quality care and increases both the length and quality of life for patients with cancer,” co-lead author Justin E. Bekelman, MD, director of the Penn Center for Cancer Care Innovation at the Abramson Cancer Center, a professor of Radiation Oncology in the Perelman School of Medicine at the University of Pennsylvania, and senior fellow at the Leonard Davis Institute for Health Economics at Penn Medicine, said in a press release.² “And yet, changing prescribing patterns has been and remains a big challenge. Based on what we found here, paying oncology practices to prescribe evidence-based drugs can serve as a valuable tactic to improve the quality of cancer care.”

Using administrative claims data covering 6.7% of US adults, researchers conducted an observation difference-in-differences study. In order to simulate a stepped-wedge study design, the investigators also leveraged the geographically staggered, time-varying rollout of the pay-for-performance program. Study participants were aged 18 years or older with breast, colon, or lung cancer who were prescribed cancer drug regimens by 1867 participating oncologists between 2013 and 2017.

The primary end point for the study was whether patient’s drug regimen was a program-endorsed, evidence-based regimen. Spending over a 6-month episode period was also evaluated.

Ultimately, the pay-for-performance program was correlated with an increase in evidence-based drug prescribing from 57.1% of patients in the preintervention period to 62.2% in the intervention period, for a total difference of 5.1 percentage points (95% CI, 3.0 percentage points to 7.2 percentage points; P < .001). In addition, the pay-for-performance program was also associated with a differential $3339 (95% CI, $1121 to $5557; P = .003) increase in cancer drug spending and a differential $253 (95% CI, $100 to $406; P = .001) increase in patient out-of-pocket spending, though no significant changes were found in total health care spending ($2772; 95% CI, -$181 to $5725; P = .07) over the 6-month episode period.

“The cost of cancer care is too high, just like other areas in health care,” senior author Amol S. Navathe, MD, PhD, an assistant professor of Medical Ethics and Health Policy at the Healthcare Transformation Institute and a senior fellow at the Leonard Davis Institute for Health Economics at Penn Medicine, said in a press release. “This program is a much-needed example of an effective program—one that improved quality of care for patients. As we look forward, we need to build on the success of this program to design programs that also decrease costs."

References:

1. Bekelman JE, Gupta A, Fishman E, et al. Association Between a National Insurer’s Pay-for-Performance Program for Oncology and Changes in Prescribing of Evidence-Based Cancer Drugs and Spending. Journal of Clinical Oncology. doi: 10.1200/JCO.20.00890

2. Offering a Pay-for-Performance Program to Oncology Practices Increases Prescriptions of Evidence-based Cancer Drugs [news release]. Philadelphia. Published October 7, 2020. Accessed October 9, 2020. https://www.pennmedicine.org/news/news-releases/2020/october/offering-pay-performance-program-oncology-practices-increases-prescrip-evidence-based-cancer-drugs