The association between clinical trial participation, drug costs, and performance in the Oncology Care Model.

Abstract

It has long been assumed that academic oncology practices are disadvantaged in value-based payment programs because of patient complexity and research costs. This assumption has not been tested. The Oncology Care Model (OCM) was a Medicare alternative payment model, which sought to curb costs while improving care. We assessed the impact of clinical trial participation on 2 outcomes: (1) cost and (2) practice performance among 3 participating National Cancer Institute-designated cancer centers using a random effects meta-analysis. The mean total Medicare cost per episode was $42 225 for clinical trial episodes and $34 937 for nonclinical trial episodes. Despite higher total costs, clinical trial episodes were more likely to be under spending targets than non-clinical trial episodes (odds ratio = 0.37, 95% confidence interval = 0.25 to 0.48). Drug costs in clinical trial episodes were lower than in nonclinical trial episodes, although this was only statistically significant at the largest volume practice. In conclusion, clinical trials may offer an advantage in value-based programs.