Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2019 Apr 5;2(4):e191549.
doi: 10.1001/jamanetworkopen.2019.1549.

Assessment of Health Care Utilization and Cost of Targeted Drug Delivery and Conventional Medical Management vs Conventional Medical Management Alone for Patients With Cancer-Related Pain

Lisa J Stearns  1 , Sanjeet Narang  2   3 , Robert E Albright Jr  4 , Krisstin Hammond  1 , Ying Xia  5 , Heather Basara Richter  6 , Gobi K Paramanandam  7 , Kelly K Haagenson  8 , Alissa H Doth  5
Affiliations
Comparative Study

Assessment of Health Care Utilization and Cost of Targeted Drug Delivery and Conventional Medical Management vs Conventional Medical Management Alone for Patients With Cancer-Related Pain

Lisa J Stearns et al. JAMA Netw Open. .

Erratum in

  • Error in Figure 2.
    [No authors listed] [No authors listed] JAMA Netw Open. 2019 May 3;2(5):e195248. doi: 10.1001/jamanetworkopen.2019.5248. JAMA Netw Open. 2019. PMID: 31099852 Free PMC article. No abstract available.

Abstract

Importance: Targeted drug delivery (TDD) has potential for cost savings compared with conventional medical management (CMM). Despite positive clinical and economic evidence, TDD remains underused to treat cancer pain.

Objective: To assess the cost of TDD and CMM in treating cancer-related pain.

Design, setting, and participants: This retrospective economic evaluation using propensity score-matched analysis was conducted using MarketScan commercial claims data on beneficiaries receiving TDD and CMM or CMM only for cancer pain from January 1, 2009, to September 30, 2015. Participants were matched on age, sex, cancer type, comorbidity score, and pre-enrollment characteristics. Data analysis was performed from June 1 to September 30, 2017.

Main outcomes and measures: Total 2-, 6-, and 12-month costs, number of health care encounters, length of hospital stay, additional components of cost, and health care utilization.

Results: A total of 376 TDD and CMM patients (mean [SD] age, 51.88 [9.98] years; 216 [57.5%] female) and 4839 CMM only patients (mean [SD] age, 51.52 [11.16] years; 3005 [62.1%] female) were identified for study inclusion. After matching, 536 patients were included in the study: 268 patients in the TDD and CMM group and 268 in the CMM only group. Compared with CMM only, TDD and CMM was associated with mean total cost savings of $15 142 (95% CI, $3690 to $26 594; P = .01) at 2 months and $63 498 (95% CI, $4620 to $122 376; P = .03) at 12 months; cost savings at 6 months were not statistically different ($19 577; 95% CI, -$12 831 to $51 984; P = .24). The TDD and CMM group had fewer inpatient visits (2-month mean difference [MD], 1.0; 95% CI, 0.8-1.2; P < .001; 6-month MD, 1.3; 95% CI, 0.8-1.7; P < .001; 12-month MD, 2.3; 95% CI, 1.2-3.4; P < .001) and shorter hospital stays (2-month MD, 6.8 days; 95% CI, 5.0-8.7 days; P < .001; 6-month MD, 6.8 days; 95% CI, 3.1-10.5 days; P < .001; 12-month MD, 10.6 days; 95% CI, 2.9-18.3 days; P = .007). Use of CMM only was associated with greater opioid use at 12 months (MD, 3.2; 95% CI, 0.4-6.0; P = .03).

Conclusions and relevance: Compared with CMM alone, TDD and CMM together were associated with significantly lower cost and health care utilization. The findings suggest that TDD is a cost-saving therapy that should be considered in patients with cancer for whom oral opioids are inadequate or produce intolerable adverse effects and should be expanded as health care systems transition to value-based models.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Drs Xia and Haagenson and Ms Doth reported being employees of Medtronic. Dr Stearns reported being a paid consultant for Medtronic, Flowonix, and Spinal Modulation and receiving research support from the Alfred Mann Foundation, Mallinckrodt Pharmaceuticals, Medallion Therapeutics Inc, Medtronic, Piramal, Nevro, and Boston Scientific for services unrelated to the current research. Dr Narang reported being a paid consultant for Medtronic for services unrelated to the current research. Dr Albright reported being a paid consultant for Medtronic for services unrelated to the current research. Dr Richter reported receiving grants from Medtronic outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Patient Selection Strategy
Patients in the targeted drug delivery (TDD) and conventional medical management (CMM) and CMM only groups before matching were selected according to the criteria described in the Study Population subsection of the Methods section. aAt least 6 months continuous health plan enrollment before the index date and at least 2 months after the index date with prescription drug coverage.
Figure 2.
Figure 2.. All-Cause Costs for the Targeted Drug Delivery (TDD) and Conventional Medical Management (CMM) Group and the CMM Only Group
ED indicates emergency department; IP, inpatient; and OP, outpatient. aStatistically significant differences for TDD and CMM compared with CMM only.
Figure 3.
Figure 3.. Medical Service and Pharmacy Utilization for the Targeted Drug Delivery (TDD) and Conventional Medical Management (CMM) Group and the CMM Only Group
ED indicates emergency department; LOS, length of stay. aStatistically significant differences for TDD and CMM compared with CMM only.
See this image and copyright information in PMC

Comment in

  • The Cost of Pain.
    Smith TJ, Hillner BE. Smith TJ, et al. JAMA Netw Open. 2019 Apr 5;2(4):e191532. doi: 10.1001/jamanetworkopen.2019.1532. JAMA Netw Open. 2019. PMID: 30951152 No abstract available.

References

    1. Mariotto AB, Yabroff KR, Shao Y, Feuer EJ, Brown ML. Projections of the cost of cancer care in the United States: 2010-2020. J Natl Cancer Inst. 2011;103(2):-. doi:10.1093/jnci/djq495 - DOI - PMC - PubMed
    1. Bluethmann SM, Mariotto AB, Rowland JH. Anticipating the “silver tsunami”: prevalence trajectories and comorbidity burden among older cancer survivors in the United States. Cancer Epidemiol Biomarkers Prev. 2016;25(7):1029-1036. doi:10.1158/1055-9965.EPI-16-0133 - DOI - PMC - PubMed
    1. Kline RM, Bazell C, Smith E, Schumacher H, Rajkumar R, Conway PH. Centers for Medicare and Medicaid Services: using an episode-based payment model to improve oncology care. J Oncol Pract. 2015;11(2):114-116. doi:10.1200/JOP.2014.002337 - DOI - PubMed
    1. Patrick DL, Ferketich SL, Frame PS, et al. National Institutes of Health State-of-the-Science Conference statement: symptom management in cancer: pain, depression, and fatigue, July 15-17, 2002. J Natl Cancer Inst Monogr 2004(32):9-16. - PubMed
    1. Panattoni LE, Fedorenko CR, Kreizenbeck KL, et al. . The role of chronic disease in the costs of potentially preventable emergency department use during treatment: a regional study. J Clin Oncol. 2017;35(15):6505. doi:10.1200/JCO.2017.35.15_suppl.6505 - DOI

Publication types

MeSH terms

Substances