What Is the Cost Impact of Second Opinions in Oncology? A Retrospective Review.

Abstract

Second opinions in oncology may optimize treatment plans, resulting in improved outcomes such as prognosis and morbidity. Changes in treatment plans are often de-escalations in treatment intensity. However, data on the cost impact of changes in cancer treatment resulting from second opinions are limited. We used a cohort of 120 patients who presented to a high-volume cancer center for a second opinion and also had a documented first opinion-30 patients each from four disease types: colorectal, head and neck, lung, and myeloma. For the 43 total patients who had a change in treatment from the second opinion compared with the first opinion, we estimated costs of treatment for the first and second opinions across the modalities of surgery, radiation, and drug treatment. Among the 43 patients with a change between the first and second opinions, seven patients had a higher cost from the second opinion, 31 had a lower cost, and five had the same cost. Averaged across all 120 cases-43 with changes in treatment and the rest without-mean cost savings were $15,015 in US dollars (USD) per patient, ranging by disease type from $2,517 USD (lung) to $43,437 USD (myeloma). Decreases in cost were due to less-intensive surgery or drug therapy regimens, or shifts from treatment to no treatment (observation). Further investigation is needed across cancer types and in other settings to confirm the finding of de-escalations and resulting cost savings from second opinions.