Shorter breast cancer treatment could hurt providers' bottom line
A widely used breast cancer drug is as effective over a shorter treatment cycle, according to new research. While shorter treatments expose patients to fewer side effects and reduce cost, they could also have a significant impact on a profitable stream of hospital revenue.
Herceptin costs about $70,000 for a full year of weekly infusions that treat early-stage breast cancer. Women who used it for six months did just as well as those who received the treatment for a year, according to research from the University of Cambridge that involved more than 4,000 patients but has yet to be peer reviewed.
The five-year survival rate was nearly identical, and patients suffered fewer side effects, including heart problems. Only 4% of women who received the drug for 6 months stopped treatment early due to heart problems, compared with 8% in the 12-month group.
"This is a win-win for patients with breast cancer who are receiving this common treatment," said Dr. Bruce Johnson, president of the American Society of Clinical Oncology, which will be presenting the research at an ASCO meeting next month.
Many health systems look to their oncology service lines as a central part of their business models. They are building new cancer centers or expanding existing facilities. Providers are also targeting partners that could bolster their cancer programs.
University of Pittsburgh Medical Center plans to spend $2 billion to build three specialty hospitals, one of which is a cancer center.
Part of what attracted Atrium Health, formerly Carolinas HealthCare System, to Navicent Health is the opportunity to grow its oncology network, executives said. Atrium spent $150 million to double the size of its Levine Cancer Institute and expects a 10% return on that investment. Cancer treatment was also a significant driver of Atrium's proposed merger with University of North Carolina, which the organizations called off in March.
"For years now, we have been hearing of stories of infusion centers that are bursting at the seams," said Lindsay Conway, a managing director at the Advisory Board Co. "For those that are desperate for new strategies to become more efficient, this is an exciting development."
Capacity could increase as more immunotherapy and biologics come to market.
That being said, women who are HER2-positive and take Herceptin or related drugs represent only about one-fifth of breast cancer patients, Conway said. Still, there are broader implications as more studies come to fruition.
As oncology drugs improve and require shorter treatment cycles, that could dent volume-based hospital revenue. But this development is a net positive for oncology providers that need extra capacity and would benefit from lower overall cost of care and fewer readmissions, which are linked to value-based models, said Naval Shanware, associate director at consulting firm Navigant.
"Given the era of bundled payments, having less treatment and fewer side effects is a big positive," he said. "At the same time, it also opens up additional resources and that goes to the bottom line."
What remains to be seen is how pharmaceutical companies will respond through possible price hikes and how much of this cost saving pans out, Shanware added.
Less exposure to toxic cancer drugs could help providers reduce readmission penalties related to cancer patients who use the emergency room within 30 days of treatment, administered under the CMS' Hospital Outpatient Quality Reporting Program, said Deirdre Saulet, a practice manager at Advisory Board. It could also lower out-of-pocket costs and improve patient satisfaction, which are important metrics in new payment models, she said.
This is an opportunity to study how long providers administer cancer drugs and at what dose, complementing research already underway at the Value in Cancer Care Consortium, Conway said.
"Anything that providers can do to improve quality or experience for cancer patients is a win," she said. "We don't have many opportunities in cancer care to do this in a significant way."
While experts expect more related analysis to follow, it won't be backed by the pharmaceutical industry. It will likely have to come from providers and the National Institute of Health, Shanware said.
Doctors are not happy that they continue to use these drugs to treat cancer patients over the long term and have no idea whether they are effective, he said.
"This is likely to become the norm and this study may be the canary in the coal mine," Shanware said.
An edited version of this story can also be found in Modern Healthcare's May 21 print edition.
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