Cancer Immunotherapy Drugs Driving End-of-Life Cost Increases

Recent increases in Medicare spending for end-of-life outpatient care were largely driven by cancer drugs — in particular, immunotherapy drugs — according to findings from a recent study.

Overall, the average total Medicare Part B payments per treated beneficiary during the last 6 months of life increased by 12% over a 4-year period, investigators found. The greatest increase was for oncology drugs, the cost for which rose by about 34%. Immunotherapy drugs accounted for 84% of the net overall increase.

Within the medical oncology category, the authors observed that drug use shifted away from less costly chemotherapy and hormone therapy agents and toward more expensive immunotherapy agents.

“We found that the growing use of immunotherapy agents led to an outsized acceleration in costs for this group,” first author Constantine A. Mantz, MD, a radiation oncologist and chief policy officer for GenesisCare, Fort Myers, Florida, said in a press release.

The findings were reported online in January in the International Journal of Radiation Oncology • Biology • Physics, a journal of the American Society for Radiation Oncology.

Over the last 6 months of life, outpatient care for patients with cancer typically account for 60% to 70% of healthcare costs. The National Cancer Institute projects that under the Medicare program, cancer-related medical care costs will rise to $221 billion by 2030. However, this estimate does not take into account the potential influence that increasing drug costs and survival might have.

Mantz and colleagues wanted to better understand the possible shifting cost landscape. The authors abstracted Medicare Standard Analytic Files for all paid claims for beneficiaries over the last 6 months of life among 84,744 Medicare beneficiaries who had been diagnosed with cancer and who died between January 1, 2016, and December 31, 2019.

Provider payments were summed by service/supply category and year of death to compare service and supply use and costs between patient groups. End-of-life care was defined as “the aggregate of medical services and supplies, including drugs furnished to cancer patients in the outpatient setting over the last 6 months of life.”

Mantz and colleagues found that over the 4-year period, the average total Medicare Part B payments per treated beneficiary during the last 6 months of life increased from $14,487 to $16,227 (12%).

The greatest increase was for oncology drugs, which rose from $7030 to $9436 (34.2%). Immunotherapy drugs, which in this study were administered to fewer than 20% of end-of-life patients, accounted for 84% of this net overall increase.

Conversely, payments for radiation oncology, the other primary modality in palliative cancer care, decreased slightly by 2.6%, from $7466 to $7276.

“While costs related to end-of-life care for nearly all cost categories have remained relatively stable, oncology drug costs overall and immunotherapy costs specifically have accelerated and account almost entirely for the observed overall increase in outpatient cost burden for Medicare,” the authors conclude.

The authors note that this study is “the first to quantify trends in utilization and cost across the different types of outpatient cancer services for Medicare beneficiaries who are at the end of life.”

How can oncologists address concerns about growing cancer costs at the end of life?

One approach “may involve expanding use of biosimilars, which follow different development and regulatory approval processes than their originator products but offer similar molecular structure, function, and efficacy at usually much lesser cost,” the authors write. “Continued development and approvals of this agent class may offer opportunity to reduce expenditures related to newer and costly immunotherapies.”

The authors also encourage communication between providers and patients to discuss treatment goals when life expectancy is limited, as well as care coordination with palliative and hospice care services to help improve “the value proposition of terminal cancer care.”

The authors report no relevant financial relationships.

Int J Radiat Oncol Biol Phys. Published online January 16, 2023. Abstract

Sharon Worcester, MA, is an award-winning medical journalist based in Birmingham, Alabama, writing for Medscape, MDedge and other affiliate sites. She currently covers oncology, but she has also written on a variety of other medical specialties and healthcare topics. She can be reached at [email protected] or on Twitter: @SW_MedReporter.

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