Service setting impact on costs for bevacizumab-treated oncology patients.

Objectives: To investigate treatment patterns and healthcare costs of patients with metastatic colorectal cancer (mCRC) or lung cancer (LC) who were treated with bevacizumab in a physician office (OFF) setting versus a hospital outpatient (HOP) setting.
Study Design: Retrospective analysis of claims from a national US health plan.
Methods: mCRC and LC patients initiating treatment with bevacizumab (index date) between January 1, 2006, and July 31, 2012, were identified. Patients were aged ≥18 years with ≥6-month pre- (baseline) and ≥6-month post index (follow-up) data, retaining patients who died with <6 months of follow-up. Differences by site of service were analyzed by χ2 and t test (bevacizumab administrations, dose) and general linear model adjusted for demographic and clinical characteristics (all-cause healthcare costs).
Results: A total of 1687 mCRC (OFF: 1292; HOP: 395) and 1232 LC patients (OFF: 983; HOP: 249) were identified. Mean age was 61.3 years, 56.3% were male, and 78% were treated in OFF. Treatment in OFF declined from 2006 (84% of patients) to 2012 (61%). For OFF versus HOP, mean length of treatment (208.3 vs 191.0 days; P=.007), number of bevacizumab administrations per month (1.4 vs 1.1; P<.001), and mean weekly dose (eg, for 2012, 4.34 vs 3.11 mg/kg, P<.05) were higher in OFF. Adjusted monthly HOP costs (vs OFF) were higher by 37.8% for mCRC patients (cost ratio=1.378; 95% CI, 1.282-1.482) and 31.1% for LC patients (cost ratio=1.311; 95% CI, 1.204-1.427) CONCLUSIONS: Despite fewer administrations and lower weekly dose of bevacizumab in HOP, adjusted total costs were 31% to 38% higher for mCRC and LC patients treated in the HOP setting.