Study: OCM Reduces Use of Some Supportive Care Medications and Boosts Filgrastim Biosimilar Use

The Oncology Care Model (OCM), begun in 2016 by CMS to promote value-based care over costly “buy and bill” pharmacy practices, has “led to reduced use of some high-cost supportive care medications, with patterns suggesting more value-conscious care,” according to findings presented at ASCO 2021.

Investigators sourced Medicare claims from 2013 to 2019 in an evaluation of outpatient supportive care medication use during chemotherapy treatment at practices participating in the OCM or in “propensity-matched comparison practices,” used as an artificial cohort.

Except for a filgrastim biosimilar analysis, where the adoption trend was assessed, the investigators used a differences-in-differences (DID) statistical method to compare findings between cohorts.

The OCM had no effect on the use of any type of bone supportive medication (denosumab or bisphosphonate) among patients with metastasized bone cancer; however, it did result in lower use of denosumab in patients with breast cancer (DID = –5.0 percentage points; 90% CI, –7.1 to –2.8), prostate cancer (DID = –4.0 percentage points; 90% CI, –5.9 to –2.2), and lung cancer (DID = –4.1 percentage points; 90% CI, –7.4 to –0.9).

The OCM resulted in lower use of neurokinin-1 (NK1) antagonists and serotonin antagonists in patients who were starting chemotherapy with high or moderate emetic risk, according to the authors. This included a 6-percentage-point reduction in use of NK1 antagonists for patients undergoing high–emetic risk chemotherapy (90% CI, –9.0 to –3.1), as opposed to no effect on antiemetic use during low–emetic risk chemotherapy.

No change was noted in use of prophylactic white blood cell growth factors among patients receiving chemotherapy with high risk for febrile neutropenia (FN).

A 7.6-percentage-point reduction in prophylactic granulocyte colony stimulating factor (G-CSF) was observed for patients with breast cancer receiving chemotherapy with intermediate risk for FN (90% CI, –12.6 to –2.7). Conversely, no change in prophylactic G-CSF use was observed for patients with lung or colorectal cancer.

The OCM resulted in faster adoption of filgrastim biosimilar vs originator product for patients treated with this agent (differential trend estimate, 2.6%; 90% CI, 1.0%-4.4%).

“Alternative payment models have potential to drive value-based changes in medication use during cancer care,” the authors concluded.

Reference

Brooks GA, Landrum MB, Kapadia NS, et al. Impact of the Oncology Care Model on use of bone supportive medications, antiemetics, and growth factors. Presented at: ASCO 2021: June 3-7, 2021. Abstract 1517.