HL Treatment at Comprehensive Cancer Centers Linked with Higher Health Plan Expenditures

Young adults diagnosed with Hodgkin lymphoma (HL) experienced higher health-plan paid (HPP) expenditures when treated at a NCI-designated comprehensive cancer center (CCC), but similar out-of-pocket expenditures.

According to a recent study, young adults with HL aged 22 to 39 years have worse outcomes than those aged younger than 21. However, treatment at CCC mitigates these outcome disparities.

To investigate if expenditures at a CCC would be higher than at non-CCC sites, the researchers compared costs for 1,154 patients treated at a CCC with 643 treated at a non-CCC.

In the year after the HL diagnosis, CCC patients had HPP expenditures of $12,869 compared with $10,688 for non-CCC patients (P=0.001). This increase in HPP expenditures was driven by several factors including higher monthly rates of CCC non-treatment outpatient hospital visits (P=0.001) and per-visit expenditures for outpatient hospital chemotherapy.

These higher expenditures did not hold true for office visits, the researchers noted, “which is likely characteristic of the structural differences between facility types.”

“These findings among the CCCs highlight the well-documented shift from office-based practices to hospital-affiliated outpatient centers among US cancer patients; this shift has been associated with higher expenditures, especially amongst commercial insurers,” the researchers wrote.

Expenditures were also higher for CCC inpatient visits ($,1813 vs. $1,091; P=0.001), which were driven by a 3.1-times higher rate of chemotherapy admissions (P=0.001). Additionally, expenditures related to radiation were also higher for CCC patients ($936 vs. $733; P=0.001) compared with non-CCC patients.

The researchers noted that the higher rate in expenditures could be do to patient-level differences such as comorbidities or higher stage of disease between CCC and non-CCC patients. Clinical trial enrollment could also have affected the results.

“It is plausible that promoting the utilization of CCCs may be one approach to improving outcomes while further work is needed to achieve this in the setting of decreased spending,” the researchers wrote.