OBJECTIVES

In a previous study of the Independent Clinical Oncology Network (ICON), in South Africa, it was demonstrated that there are cost savings when treatment plans comply to ICON’s evidence based protocols. A criticism of protocolising treatments is the possibility of denial of care. This study focuses on the care of prostate cancer patients using three quality assurance (QA) measures to reflect whether they receive appropriate care.

METHODS

Three prostate cancer QA metrics were carefully constructed by a group of oncologists. Thresholds were defined by these oncologists, based on expert opinion, from which a determination is made whether the overall results are generally compliant. Compliance reflect on whether appropriate care choices are being made and as a corollary, whether care was denied.

The metrics are measured in a third-party funder environment. Claims and authorisation data was matched to ensure confirmation of treatment and to acquire necessary clinical detail. The metrics were extracted over two calendar years (2015 and 2016) and a total of 3686 patients of which 652 has prostate cancer were included.

The first metric measures whether patients that are treated curatively have a PSA score of larger than forty at diagnosis (upper threshold of 15%). The second metric measures whether high-risk patients receive adjuvant hormonal therapy (lower threshold of 75%). Finally, the third metric measures whether bone scans are used in low-risk prostate cancer (upper threshold of 10%).

RESULTS

The results for 2016 are 8% (PSA > 40), 75% (adjuvant hormonal therapy) and 9% (bone scans in low-risk patients). All three metrics were at least equal to or within the defined thresholds. The 2015 data showed similar results.

CONCLUSIONS

Based on the results of the QA metrics for prostate cancer, the providers using the ICON solution show no indication of denying care and are generally compliant with evidence-based practice.