Economic Influences on Medical Decision-Making in Cancer Medicine: An Analysis of Qualitative and Quantitative Data

OBJECTIVES: Economic considerations influence medical decision-making in cancer medicine. However, little is known about physician decisions that are economically influenced and to what extent. The ELABORATE project aims to identify and analyze the influence of economic considerations on decision-making situations in cancer medicine using qualitative and quantitative data.

METHODS: Semi-structured interviews were conducted with physicians experienced in budgeting and controlling in cancer medicine (n=17). Qualitative content analysis was used to identify cancer-related decision-making contexts in which interviewees perceived certain medical decisions to be economically influenced. Using claims data from a statutory health insurance (SHI) fund, we then analyzed how often each decision-making context occurred, which decisions were taken in each context and which factors potentially influenced these decisions. In doing so, we excluded those situations that could not be isolated in the SHI dataset.

RESULTS: The interviews identified 21 decision-making situations in cancer care in which medical decisions were potentially influenced by economic considerations. For example, in the outpatient setting, the oncologist’s decision to choose between subcutaneous or intravenous administration of cancer therapeutics is influenced by economic considerations due to differing reimbursement mechanisms. In particular, intravenous administration is associated with higher reimbursement. To examine this in SHI claims data, two systemic therapies with both modes of administration were selected as use cases: rituximab for B-cell lymphoma and trastuzumab for HER2-positive breast cancer. Between 2014 and 2022, intravenous administration was used in 91.43% of rituximab and 85.26% of trastuzumab therapies in the respective populations.

CONCLUSIONS: Qualitative and quantitative analyses indicate that economic considerations influence specific medical decision-making situations in German cancer medicine, as suggested by the use cases. These influences could potentially reduce quality of patient care and consume financial resources that may be needed in other areas of healthcare.Therefore, further discussion and guidance on how to address economic influences in cancer medicine is needed.