ALBERT

Description: Background: Hospital acquisitions of community clinics in the United States have led to a shift in oncology infusion therapy from physician office (PO) to hospital outpatient (HO) settings. Studies in commercially insured populations suggest that inherent differences between sites of care (SOC) can impact cancer treatment delivery and overall health care costs. This study utilizes a predominantly Medicare population to examine differences in treatment patterns, cost, and quality of care among patients with NHL/CLL receiving infusion chemotherapy and/or rituximab in a HO versus PO setting. Methods: Patients ≥ 18 years initiating infusion therapy in 2008-2012 with at least 2 claims with a diagnosis of NHL or CLL occurring 30 or more days apart were identified from Humana medical claims data. The index date was the date of the first NCCN recommended infusion therapy. SOC attribution (HO vs PO) was based on where patients received ≥ 90% of their infusions. Differences by SOC in duration of first line treatment, number of infusions, and quality of care indicators, such as the use of infusions or hospitalizations within 30 days of death, were evaluated using Χ2 and Wilcoxon Rank Sum tests. Median and interquartile range for duration of treatment and number of infusions by SOC were reported. Health care costs were determined by the sum of plan and patient costs for medical and pharmacy claims in the 6-months following the index date. Oncology costs, including supportive care, were computed from claims with cancer specific ICD-9 diagnostic codes. To control for the impact of case mix differences by SOC on costs, generalized linear models adjusting for age, sex, comorbidity, total health care cost in the pre-index period and geographic region were conducted. Results: A total of 1,859 patients with a diagnosis for NHL or CLL were identified and 68% (1,262) received infusion therapy in the PO setting. Medicare beneficiaries represented 85% (1,587) of the study sample. Mean comorbidity index was higher among HO [3.7 ± 2.4 (SD)] compared to PO patients [3.3 ± 2.2 (SD)], p=0.0001. The proportion of patients receiving certain treatment regimens differed by SOC. Rituximab monotherapy was received by 24.5% (146) of HO and 14.1% (178) of PO patients, p