OBJECTIVES

: A previous study by the Independent Clinical Oncology Network (ICON), in South Africa, demonstrated that treatment plans submitted using ICON’s evidence-based protocols result in cost savings. Protocolised treatments are often criticised for possible cost shifting and or compromising clinical care. The aim of this study was to measure oncologist managed hospitalisation events, as a proxy outcome for: clinical need, an indicator of patient well-being, and potential cost shifting because of protocolised treatment. Access to hospitalisation was unrestricted and similar (not protocolised) across the cohort to be studied.

METHODS

: A retrospective analysis was conducted of claims data, acquired from third party funders that contract the ICON Network, for the year 2016. The data (n₁=9444) was governed by a requirement to adhere to treatment protocols. The control group (n₂=2008) was under no protocol restriction and seen by a different group of oncologists. The hospital admission rate and total stay duration were measured per patient where the treating doctor for the hospital event was an oncologist. Case mix was adjusted by diagnosis (using admission ICD10 code). The smaller cohort dataset (n) was extrapolated proportionally by diagnosis (random sampling with replacement). The same methodology was applied to 2015 data to validate the methodology.

RESULTS

: The hospitalisation rate for patients under protocolised treatment, 16.07%, was significantly less (99% CI, p<0.0022, Chi-squared test) than the control group, 17.64%. The average hospital stay duration, 1.62 days, for patients under protocolised treatment was also significantly less (99% CI, p<0.0022, student’s t test) than the control group, 1.95 days. The results were validated against data from 2015 (n₁=8559, n₂=1870): that showed significantly lower hospitalisation rate and hospital stay duration in comparison to the control group.

CONCLUSIONS

: Using hospitalisation metrics as a proxy outcome of patient well-being and cost shifting, the ICON solution demonstrates significant value without compromising care.