Immunotherapy accounts for a majority of Medicare cancer spending increase in end-of-life setting

Immunotherapy costs account for 84% of an observed overall increase in Medicare outpatient cancer care spending for patients in the end-of-life setting, despite immunotherapy only being given to less than 20% of patients, according to data published in the International Journal of Radiation Oncology • Biology • Physics.¹

"We found that the growing use of immunotherapy agents led to an outsized acceleration in costs," said Constantine Mantz, MD, FASTRO.

“Our 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. We found that the growing use of immunotherapy agents led to an outsized acceleration in costs for this group,” said lead author Constantine Mantz, MD, FASTRO, in a news release on the findings.² Mantz is a radiation oncologist and Chief Policy Officer for GenesisCare.

Investigators retrospectively analyzed medical services and supplies utilized by Medicare beneficiaries with a cancer diagnosis throughout their last 6 months of life. This rendered claims data from 84,744 patients with cancer who had died between January 1, 2016 and December 31, 2019.

The study evaluated end-of-life care in patients across all cancer types, including 3343 patients with disseminated prostate cancer and 3756 patients with localized prostate cancer. A total of 3078 patients with disseminated non-prostate genitourinary (GU) cancer and 2282 with localized non-prostate GU cancer were also identified.

Data showed that the average Medicare Part B payments per treated beneficiary over the last 6 months of life increased by 12%, from $14,487 to $16,227. The greatest contributor to this increase was attributed to medical oncology, where payments shifted away from chemotherapy and hormone therapy agents and toward more costly immunotherapy agents. The absolute cost increase observed in this category was 34.2%, with payments rising from $7030 to $9436.

Specifically, payments related to immunotherapy agents rose by 29.9%, or $4193, in Medicare payments per beneficiary, and utilization rose from 11.8% to 17.1% over the study period. Immunotherapy utilization and costs accounted for 84%, or $595 million, of the 12% net increase in Medicare Part B payments, yet the treatment was administered to fewer than 20% of end-of-life patients in this study.

Radiation oncology, on the other hand, maintained a nearly constant 15% utilization rate and observed a payment decline of 2.4%. All other drug supply categories analyzed showed a decrease in utilization, and almost all Medicare Part B payments in other service/supply categories increased modestly.

Mantz commented on the controversy of using immunotherapy in patients in the end-of-life setting, saying, “If the trade-off for [adverse events] and higher costs is improved survival and quality of life, then I’m entirely supportive. We can argue about what the price may be, but I don’t think we can argue about the net benefit provided to the patient in terms of their overall health. What can be problematic is the continued use of a treatment that imposes some meaningful risk of [adverse events] for patients approaching the end of life. We have to get better at recognizing who those patients are near the end of life and, when appropriate, transitioning them to less risky, less expensive therapies.”

References

1. Mantz CA, Yashar CM, Bajaj GK, Sandler HM. Recent trends in Medicare payments fro outpatient cancer care at the end of life. Int J Radiat Oncol Biol Phys. an 16;S0360-3016(23)00028-7. doi: 10.1016/j.ijrobp.2023.01.005.

2. Immunotherapy costs drive increase in Medicare spending for outpatient cancer care at the end of life. News release. American Society for Radiation Oncology. Published online February 27, 2023. Accessed February 28, 2023. https://www.newswise.com/articles/immunotherapy-costs-drive-increase-in-medicare-spending-for-outpatient-cancer-care-at-the-end-of-life?sc=mwhr&xy=10016681