Purpose: To assess the impact of the cancer support program (CSP), a telephonic case management program led by oncology nurses, on cancer-related medical costs and hospice use.
Methods: Members of large employer-funded health plans were referred to the CSP if they had a cancer diagnosis and met program criteria. Patients were referred to the CSP (July 2009-June 2011; index date is referral date) and chose to participate (participants) or not (nonparticipants). Inclusion required continuous coverage for ≥ 6 months preindex and ≥ 1 month postindex. Monthly cancer-related medical costs were estimated separately for survivors with active baseline cancer treatment and decedents. A sensitivity analysis of total cancer-related costs was conducted for the subset of patients (approximately 33%) with pharmacy data. Hospice use was determined for decedents. All outcomes were analyzed with generalized linear models adjusted for propensity score weights computed from patient baseline characteristics.
Results: A total of 7,455 survivors (3,255 CSP participants, 4,190 nonparticipants) and 1,388 decedents (736 CSP participant, 652 nonparticipants) were included. Participant monthly cancer-related medical costs were 9.8% lower for survivors over 6 months and 28.2% lower for decedents in the last month of life (P < .01). Cost savings were driven by lower inpatient costs for survivors (57.8% lower) and decedents (81.3% lower). The sensitivity analysis confirmed costs savings for survivors, but not decedents. Cumulative hospice days were higher for participants versus nonparticipants in the last month of life (participants, 16.4, nonparticipants, 12.8; P = .04).
Conclusion: Self-selected participation in the cancer support program was associated with lower-cancer-related medical costs and greater hospice use.
Copyright © 2014 by American Society of Clinical Oncology.