Impact of the Oncology Care Model on Use of Bone Supportive Medications, Antiemetics, and Growth Factors

An observational study indicates that the Oncology Care Model led to reduced use of some high-cost supportive care medications, suggesting the potential for alternative payment models to drive value-based changes in cancer medication use.

The Oncology Care Model (OCM) is a voluntary, value-based cancer care model that offers incentives to reduce spending during chemotherapy treatment. An observational study evaluated the impact of the OCM alternative payment model on the use of bone supportive care medications, antiemetics, and growth factors during chemotherapy episodes; the results of this study were reported at the 2021 American Society of Clinical Oncology Annual Meeting.

The data source for the analysis was 100% Medicare fee-for-service claims (2013-2019). Chemotherapy episodes assigned to OCM practices (n = 186) or propensity-matched comparison practices (n = 534) were evaluated for use of outpatient supportive care medications. The 3 outcome measures were: (1) use of bisphosphonates and/or denosumab in beneficiaries with bone metastases from breast, lung, or prostate cancer; (2) prophylactic use of neurokinin-1 antagonists and long-acting serotonin antagonists; and (3) prophylactic use of white blood cell growth factors (granulocyte colony-stimulating factors) in beneficiaries starting chemotherapy for breast, lung, or colorectal cancer (use of biosimilar filgrastim was separately evaluated). Analyses used the difference-in-differences approach (before vs after OCM implementation); adoption trend was assessed in the filgrastim biosimilar analysis.

The OCM did not affect use of any bone supportive medication (denosumab or bisphosphonate) for bone metastases; however, the OCM led to a relative decrease in the use of denosumab for breast cancer, prostate cancer, and lung cancer. Although the OCM led to reductions in prophylactic use of neurokinin-1 antagonists and long-acting serotonin antagonists during high or moderate emetic-risk chemotherapy regimens, there was no impact on antiemetic use during low emetic-risk chemotherapy. The OCM did not impact use of prophylactic white blood cell growth factors during chemotherapy that was high risk for febrile neutropenia but led to reduction in prophylactic granulocyte colony-stimulating factor use for patients with breast cancer receiving chemotherapy with intermediate risk for febrile neutropenia. The OCM led to faster adoption of biosimilar compared with originator filgrastim.

Based on these data, it was concluded that the OCM led to reduced use of some high-cost supportive care medications, suggesting the potential for alternative payment models to drive value-based changes in cancer medication use.

Source: Brooks GA, Landrum MB, Kapadia NS, et al. Impact of the Oncology Care Model on use of bone supportive medications, antiemetics, and growth factors. J Clin Oncol. 2021;39(suppl_15):1517.