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This Week in Managed Care: June 15, 2018
June 15, 2018

Cost Conversations in Oncology Care Led to Alternate Cost-Reducing Interventions

Surabhi Dangi-Garimella, PhD
Oncologist- as well as patient-initiated conversations on the cost of cancer care led to conversations on cost-reducing strategies 38% of the time, according to a new study published in the Journal of Oncology Practice.
Oncologist- as well as patient-initiated conversations on the cost of cancer care led to conversations on cost-reducing strategies 38% of the time, according to a new study published in the Journal of Oncology Practice.

Researchers from Duke University, Michigan State University, and Verilogue analyzed transcribed reports of patient-physician dialogue from 677 outpatient breast oncology visits in clinics across the United States. These conversations were documented in 19 states, across 56 community-based or private-practice oncologists, between June 2010 and August 2013. The information was accrued from Verilogue’s Point-of-Practice database, which includes audio recordings from routine clinical care visits.

Cost conversation was defined by the researchers as any mention of the patient’s out-of-pocket costs or insurance coverage for a past, existing, or future healthcare service. Once identified, the conversation was then scanned to identify:
  • Who initiated the cost discussion?
  • How long did the conversation last?
  • Were strategies identified to reduce patient cost?
  • Would the intervention save costs for: antineoplastic therapy, ancillary services and supplies, diagnostic tests, or other?
Overall, less than 25% of clinic visits (147 of 677) included a cost conversation, and they were more common when the oncologist was female (30%) rather than male (21%; P = .054). Physician-initiated discussions were more common in this study population—59% compared with 37% patient-initiated conversations (<.001); white patients more commonly brought up cost-of-care discussions (12% of visits) compared with black patients (3% of visits; P = .001).

The most common topics were:
  • Antineoplastic therapy (39%)
    • Endocrine therapies (14%)
    • Targeted agents (11%)
    • Chemotherapy (7%)
    • Bone therapies (7%)
  • Diagnostic testing (27%)
    • Staging/restaging scans (16%)
    • Laboratory tests (6%)
    • Cardiac function tests (4%)
  • Symptom/comorbidity treatment (17%)
  • Ancillary services/supplies (10%)
While oncologists mainly focused their conversation around pharmacotherapies during initial cost discussions (62%), patients were concerned with the cost of nonpharmacologic interventions (57%). Patients were also more likely to bring up costs associated with physician office visits, cost of surgery, radiation therapy, etc (13% compared with 2% of physicians; P = .03).  

While the duration of conversation did not depend on who initiated the conversation, it lasted for a median time of 33 seconds in an appointment that was 12 mins and 2 secs long (median; range, 6 mins and 54 secs–15 mins 57 secs).

Strikingly, strategies for cost reduction did not take precedence in these conversations; they were observed only 38% of the time, and were nearly equally divided between changing the patient’s care plan (51%) or not (49%).  

The results suggest that despite the time constraints on a clinic visit, oncologists and patients with breast cancer are willing, and capable, of holding cost conversations, the authors write. However, they recommend additional research is necessary to determine the impact of these conversations on clinical, economic, and patient-centered outcomes that will allow effective and efficient cost conversations along the spectrum of disease stage.

Reference

Hunter WG, Zafar SY, Hesson A, Davis JK, Kirby C, Barnett JA, Ubel PA. Discussing health care expenses in the oncology clinic: analysis of cost conversations in outpatient encounters [published online August 23, 2017]. J Oncol Pract. 2017:JOP2017022855. doi: 10.1200/JOP.2017.022855.

 
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