Founded at the Abramson Cancer Center at the University of Pennsylvania

Direct and Spillover Impact of Utilization Management Policy on Uptake of Hypofractionated Radiation in Early-Stage Breast Cancer

Long radiation treatment unnecessary

Breast cancer accounts for the largest portion of cancer-related spending in the United States. In prior work, we have 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, we 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, we found 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.

Ravi Parikh, MD; Atul Gupta, PhD; Justin Bekelman, MD

Anthem, Inc., HealthCore, AIM Specialty Health, and the Wharton School’s Department of Health Care Management

Payments Models and Affordability

Association of utilization management policy with uptake of hypofractionated radiotherapy among patients with early-stage breast cancer. DOI: 10.1001/jamaoncol.2020.0449.

Uptake and Costs of Hypofractionated vs Conventional Whole Breast Irradiation After Breast Conserving Surgery in the United States, 2008–2013.

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