Direct and Spillover Impact of Utilization Management Policy on Uptake of Hypofractionated Radiation in Early-Stage Breast Cancer
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.
Anthem, Inc., HealthCore, AIM Specialty Health, and the Wharton School’s Department of Health Care Management
Payments Models and Affordability