Direct and Spillover Impact of Utilization Management Policy on Uptake of Hypofractionated Radiation in Early-Stage Breast Cancer
- Payment Models & Affordability
This project assessed the impact of a large commercial payer's utilization management policy on hypofractionated radiation use & associated spending for patients with breast cancer. Findings showed that utilization policy was associated with increased hypofractionated radiation use for patients directly & indirectly affected by the policy.
Breast cancer accounts for the largest portion of cancer-related spending in the United States. Prior work has shown that while hypofractionated radiation following breast conservation surgery is cost effective and convenient in early-stage breast cancer, less then 40% of eligible women received this treatment. In this study, PC3I researchers assess the impact of a large commercial payer’s utilization management policy on hypofractionated radiation use and associated spending.
In this economic analysis of 10,540 women with early-stage breast cancer, findings showed that the utilization policy was associated with increases in hypofractionated radiation use for both patients directly and indirectly affected by the policy. Utilization management was not associated with measurable cost savings.
Elevance Health; Carelon; AIM Specialty Health; Wharton School’s Department of Health Care Management
Project Leads
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Ravi Parikh
MD, MPP, FACP
Associate Director, PC3I & Director, Program in Augmented and Artificial Intelligence, PC3I
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