Physician-Based Active Cost Management of Oncological Therapies Reducing Pharmaceutical Costs by 83.4% in Two Years without Leaving Standard of Care

Abstract

We report about the 2-year results of a physician-based active cost management model for oncological therapies in a German OB/GYN university clinic. Over 2 years more than 4,000 oncological cycles were prospectively and individually analyzed regarding costs and reimbursement mode. Main aim was reducing costs without lowering cycle number and standard of care. Within two years pharmaceutical costs were reduced by 83.4% or 785,976.- EUR. All causes for a previous financial loss were identified and eliminated. Debts were paid back and employment of new staff and investments were possible. With this first active cost management model by and for physicians, oncological therapies can be performed cost covering even in a university clinic. Although developed for optimization of cost coverage of oncological therapies in Germany, this model is universally transferable.

Health resource consumption and costs attributable to chemotherapy-induced toxicity in German routine hospital care in lymphoproliferative disorder and NSCLC patients

“…Moreover, in the light of the observed high variability of TMC-TC in daily clinical care, hospital decision makers should interpret alleged differences in assumption-driven cost computations based on label-congruent regimens with caution. In this context, prospective studies or models incorporating observational data should be juxtaposed to Drugs 97 [20] (67-126)…”

“…In this context, real-word data can serve as cost estimates in health economic modelling [19]. Moreover, knowledge of the actual cost of supportive care permits comparison with flat-rate reimbursement, which is not necessarily fully cost covering [9,20].…”

Relevance of Health Economics in Breast Cancer Treatment: Integration of Economics in the Management of Breast Cancer at the Clinic Level

“…Based on and derived from this information, cost drivers can preferably be identified, and a cautious and gentile long-term optimization process can be induced towards a care-to-reimbursement adjustment. Over the years a variety of successful projects have evolved among them; optimizing chemotherapy reimbursement with reduction of oncological pharmaceutical costs by over 83% in just 2 years without changing quality of care [26,27,28], comparison of different chemoregimen [29], process analysis to discover mistakes in ordering, cost attribution, documentation, coding and billing for out-patient chemotherapies [30], prospective analysis of cost and reimbursement for participation in clinical trials [31], identification of off-label status for pharmaceuticals which are not reimbursed by statutory healthcare funds [32], analysis of costs and financial risks of expensive breast implants at 90% under-reimbursed in immediate breast reconstruction after mastectomy [33], prospective study of provider's costs of chemotherapy-related complications such as febrile neutropenia [34] and analysis and optimization of their correlating DRG reimbursement [35], prospective calculation of direct medication cost savings by biomarkers for avoiding chemotherapy in breast cancer at medium relapse risk [36], purchase and contract adjustments for reduction of costs of expensive breast ultrasound equipment to actual clinical needs [37], and identifying unexplainable reimbursement differences of mastectomy between prophylactic BRCA1/BRCA2 and breast cancer patients [38]. Even concordance of biomarker test results to Tumor Board decisions and final therapy can result in economic effects which can be used to optimize cost for their application [39].…”

“…This has already proven to be cost-effective, e.g. understanding of costs for chemo-related febrile neutropenia prophylaxis medication vs. their reimbursement [48], reducing in-patient costs for chemotherapy by €900,000 per year [28], and has even lead to a new profession [24,25]. …”

Current Status of Financing and Reimbursement of Trastuzumab (Herceptin^®) for Adjuvant and Advanced Therapy of Breast Cancer in Germany

“…Depending on these factors, performing trastuzumab therapy can be either cost-covering for the institution or cause big financial losses which the institution has to cover with its own budget. Hence, this affects physicians' therapy decision [20] and requires an understanding of all financial aspects of performing oncological therapies [21] as well as active cost management, preferably by the oncological care provider [22,23]. Since the pharmaceutical costs for a 1-year trastuzumab therapy alone equal a 1-year salary of a full-time physician, the financial risks of no or incomplete reimbursement of the costs need to be fully evaluated in advance.…”