Economic value of a cancer case management program.
OBJECTIVE
To assess the impact of the cancer support program (CSP), a telephonic case management program led by oncology nurses, on cancer-related medical costs and hospice use.


METHODS
Members of large employer-funded health plans were referred to the CSP if they had a cancer diagnosis and met program criteria. Patients were referred to the CSP (July 2009-June 2011; index date is referral date) and chose to participate (participants) or not (nonparticipants). Inclusion required continuous coverage for ≥ 6 months preindex and ≥ 1 month postindex. Monthly cancer-related medical costs were estimated separately for survivors with active baseline cancer treatment and decedents. A sensitivity analysis of total cancer-related costs was conducted for the subset of patients (approximately 33%) with pharmacy data. Hospice use was determined for decedents. All outcomes were analyzed with generalized linear models adjusted for propensity score weights computed from patient baseline characteristics.


RESULTS
A total of 7,455 survivors (3,255 CSP participants, 4,190 nonparticipants) and 1,388 decedents (736 CSP participant, 652 nonparticipants) were included. Participant monthly cancer-related medical costs were 9.8% lower for survivors over 6 months and 28.2% lower for decedents in the last month of life (P < .01). Cost savings were driven by lower inpatient costs for survivors (57.8% lower) and decedents (81.3% lower). The sensitivity analysis confirmed costs savings for survivors, but not decedents. Cumulative hospice days were higher for participants versus nonparticipants in the last month of life (participants, 16.4, nonparticipants, 12.8; P = .04).


CONCLUSIONS
Self-selected participation in the cancer support program was associated with lower-cancer-related medical costs and greater hospice use.
Optum, Golden Valley; Optum, Minneapolis, MN; Optum, Lisle, IL; and Optum, Ann Arbor, MI charlotte.wu@optum.com.
Charlotte
C
Wu
Optum, Golden Valley; Optum, Minneapolis, MN; Optum, Lisle, IL; and Optum, Ann Arbor, MI.
Wade
W
Bannister
Optum, Golden Valley; Optum, Minneapolis, MN; Optum, Lisle, IL; and Optum, Ann Arbor, MI.
Pamela
P
Schumacker
Optum, Golden Valley; Optum, Minneapolis, MN; Optum, Lisle, IL; and Optum, Ann Arbor, MI.
Michael
M
Rosen
Optum, Golden Valley; Optum, Minneapolis, MN; Optum, Lisle, IL; and Optum, Ann Arbor, MI.
Ronald
R
Ozminkowski
Optum, Golden Valley; Optum, Minneapolis, MN; Optum, Lisle, IL; and Optum, Ann Arbor, MI.
Arthur
A
Rossof
D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D019468:Disease Management; D005260:Female; D017048:Health Care Costs; D017051:Hospice Care / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000191:economics* / Q000401:mortality / Q000628:therapy; D010166:Palliative Care / Q000191:economics*; D012189:Retrospective Studies; D016896:Treatment Outcome