OBJECTIVES : The Oncology Care Model (OCM), developed by the Centers for Medicare and Medicaid Services (CMS) Innovation Center, is intended to improve the quality and coordination of oncology care through an incentive-based payment structure. This study evaluated trends in the use of granulocyte colony-stimulating factor (G-CSF) prophylaxis to prevent febrile neutropenia (FN), incidence of FN, and FN-related expenditures among cancer patients receiving chemotherapy in OCM and non-OCM practices.

METHODS : A retrospective design and Medicare Research Identifiable Files (01/2012-12/2018) were employed. Study population included patients who received ≥1 course of myelosuppressive chemotherapy for non-myeloid malignancies; all qualifying courses (maximum 8 cycles per course) were arrayed longitudinally and subsequently stratified into OCM and non-OCM practices, both before and after implementation of the OCM program (07/2016). Use of G-CSF prophylaxis, FN events and FN-related expenditures (2018US$) were descriptively evaluated on a monthly basis over the study period.

RESULTS : The study population included 95,881 OCM patients (no. of courses: pre-OCM, 59,002; post-OCM: 57,800) and 473,496 non-OCM patients (no. of courses: pre-OCM, 294,434; post-OCM: 292,423). Baseline characteristics were comparable between OCM and non-OCM patients, in the pre-OCM and post-OCM periods. Use of G-CSF prophylaxis among OCM patients was 42% at the time of OCM implementation versus 38% at the end of follow-up; corresponding values for non-OCM patients were 35% and 30%. FN incidence proportions were: 19% vs. 18% for OCM patients; and 18% vs. 16% for non-OCM patients. Mean FN-related expenditures (per patient) were: $2,426 versus $2,239 for OCM patients; and $2,768 versus $2,535 for non-OCM patients.

CONCLUSIONS : In this large retrospective observational study of Medicare patients receiving myelosuppressive chemotherapy for myeloid malignancies, trends in G-CSF use and FN incidence appear to be comparable among patients treated in OCM and non-OCM practices, while FN-related expenditures were nominally lower among OCM patients versus non-OCM patients.