Budget Impact of Shifting the Treatment Setting of Unresectable Liver Metastases Associated with Primary Colorectal Cancer Using Y-90 Resin Microspheres from the Outpatient Hospital to the Office-Based Laboratory.

Abstract

Purpose: In the wake of ever-increasing health care costs, solutions are sought to make health care more affordable, such as moving hospital outpatient procedures to office-based laboratory (OBL) settings. A budget impact model was constructed to estimate the health plan cost benefit of moving 50% of yttrium-90 resin microspheres (Y-90) selective internal radiation therapy (SIRT) procedures for unresectable liver metastases associated with primary colorectal cancer (CRC) from a traditional hospital outpatient setting (HOPPS) to an OBL setting.

Methods: The eligible population was estimated using an incidence-based approach for a hypothetical health plan with 1 million covered lives. Modeled costs were based on 2024 Medicare reimbursement rates. Three treatment scenarios were considered: 1) base case HOPPS, 2) hybrid (HOPPS/OBL), and 3) OBL settings. Budget impacts were estimated as the differences in annual total cost of treatment after switching 50% of Y-90 SIRTs from HOPPS to the hybrid (HOPPS/OBL) or OBL setting. Per-member-per-month (PMPM) budget impacts were also calculated. Sensitivity analyses were conducted by varying the proportions of patients shifting settings and the treatment setting they were shifting into.

Results: Annually, 28 patients were estimated to have metastatic CRC and unresectable liver metastases in a health plan of 1 million members. Average estimated per-patient cost savings would be $8,791 by switching one patient to a hybrid setting and $17,697 for a patient switched to the OBL. Switching 50% of eligible procedures resulted in PMPM cost benefits to the plan of $0.0102 for hybrid setting and $0.0206 for OBL. In sensitivity analyses, annual cost savings for the health plan were affected by both the proportion of patients shifted and the setting they were shifted into.

Conclusion: Shifting a percentage of the treatment of unresectable liver metastases with Y-90 SIRT to the OBL setting results in modest cost benefits for US health plans.