Author of

• 18749

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  P3.07 - Poster Session with Presenters Present (ID 493)

  • Event: WCLC 2016
  • Type: Poster Presenters Present
  • Track: Regional Aspects/Health Policy/Public Health
  • Presentations: 1
  • Moderators:
  • Coordinates: 12/07/2016, 14:30 - 15:45, Hall B (Poster Area)

  • 18765

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    P3.07-016 - Ontario's Episode-Based Funding Model Reveals Practice Variation in Adjuvant NSCLC Chemotherapy (ID 5688)

    14:30 - 14:30  |  Author(s): V. Simanovski
    • Abstract

    Background:
    A new episode-based funding model (FM) for ambulatory systemic therapy was implemented in Ontario, Canada in April 2014. The FM bundled reimbursement for components of care, including initial consultation, treatment episodes delivered with adjuvant/curative (AC) or palliative intent and supportive care. Options for evidence-informed AC regimens and their optimal number of treatment cycles and chemotherapy suite visits were informed by the provincial lung Disease Site Group (DSG) based on published literature or group concensus. It was expected that cisplatin-vinorelbine (CISPVINO) would be the most commonly used regimen as CISPVINO was used in the clinical trial conducted in Canada that established CISPVINO as a standard of care and is recommended in Ontario’s adjuvant chemotherapy practice guideline.
    
    Methods:
    The utilization of AC was analyzed for 35 systemic treatment facilities in Ontario comparing actual practice (AP) with “best practice” (BP) (cycle number). For this analysis, cases were included if they started a new course of AC after January 1, 2014 and completed the treatment before July 30, 2015.
    
    Results:
    The percentage of patients with stage II/IIIa NSCLC receiving AC has been stable at 50-55% for over five years. In this analysis 1,531 cases received some form of AC. 506 cases received chemotherapy with XRT (usually etoposide-cisplatin) and these cases were assumed to be Pancoast tumours or stage IIIa disease on neoadjuvant therapy. The most common regimens prescribed without XRT were cisplatin-vinorelbine (CISPVINO) (331 cases) cisplatin-etoposide (222), carboplatin-etoposide (154) and carboplatin + vinorelbine (74 cases). For all adjuvant chemotherapy excluding XRT (1,025 cases), AP was equal to BP in only 24 % of cases, AP BP in 4%. For CISPVINO, AP=BP was achieved in only 36%, AP< BP in 55% and AP > BP in 9%. For the top 5 hospitals by volume administering AC, BP=AP ranged from 8-45%; AP< BP ranged from 41-73%; AP > BP occurred in 20 cases in 3 facilities.
    
    Conclusion:
    This analysis of first-year funding data provided insights on how adjuvant chemotherapy is administered in Ontario. As expected, CISPVINO was the most commonly used AC regimen (32%) when AC was used alone. However, etoposide-cisplatin was also commonly used alone and in combination with XRT and carboplatin was frequently substituted. BP is only achieved in the minority of cases and there is wide institutional variance. Reasons for this variation need to be better understood and opportunities identified to drive efficiency and standardization.