Patterns of chemotherapy administration in patients with intermediate-grade non-Hodgkin's lymphoma.

Records from 653 patients treated between 1991 and 1998 in the Oncology Practice Patterns Study (OPPS) were analyzed to determine contemporary chemotherapy delivery patterns in patients with intermediate-grade non-Hodgkin's lymphoma (NHL). Of the 653 patient records reviewed, 90 (14%) omitted an anthracycline or mitoxantrone (Novantrone) from primary therapy. Among patients receiving CHOP (cyclophosphamide [Cytoxan, Neosar], doxorubicin HCl, vincristine [Oncovin], prednisone) or CNOP (cyclophosphamide, mitoxantrone, vincristine, prednisone), 134 (27%) of 492 received an average relative dose intensity of less than 80% of the literature-referenced dose, due either to an inadequate planned or delivered dose. Of 181 advanced-stage patients with responsive disease, 28 (15%) failed to receive at least six treatment cycles. Overall, 283 (43%) of 653 patients potentially received suboptimal chemotherapy due either to choice of regimen or chemotherapy delivered. Patient age > or = 65 years and cardiac comorbidity appeared to have the greatest influence on a physician's decision regarding chemotherapy administration. Among the 492 patients who received CHOP or CNOP, 235 (48%) experienced a delay or reduction in chemotherapy dose (usually neutropenia-related), 100 (20%) developed mucositis, and 116 (24%) were hospitalized for febrile neutropenia. Growth factor was administered to 261 patients (53%), and its primary prophylactic use was associated with a significant reduction in the incidence of hospitalizations for febrile neutropenia in all patient subgroups receiving appropriate chemotherapeutic dose intensity (P = .02). This assessment of chemotherapy delivery to patients with intermediate-grade NHL showed significant variation from current standards. Further analysis of factors influencing chemotherapy delivery might improve therapeutic outcomes.

Health resource utilization in ABMT with and without G-CSF in stage III/IV breast cancer patients.

G-CSF has been available since 1991 for use in patients receiving high-dose chemotherapy/ABMT, and while it has been shown to effectively reduce the risk of febrile neutropenia, its cost effectiveness has been open to question. In this small retrospective study, five indicators of the consumption of health care resources were examined in stage III/IV breast cancer patients who received high-dose chemotherapy with ABMT or peripheral stem cell support. The study covered the time periods before and after the availability of G-CSF. The results showed that patients who received G-CSF had reductions in length of hospital stay of 20% (the purged marrow group) and 17% (nonpurged group), compared with similar groups that did not receive the growth factor; the shortest lengths of stay were seen in the peripheral stem cell group, all of whom received G-CSF. Other findings, including number of days the ANC fell below 500, total days of G-CSF use, and total days of antibiotic use, are presented.

Cost-effectiveness of autologous bone marrow transplantation.

The impact of filgrastim on the use of health care resources during recovery from autologous bone marrow transplantation (ABMT) was studied. The charts for patients with metastatic breast cancer treated with ABMT at a general hospital between November 1989 and July 1993 were reviewed by Blue Cross of Western Pennsylvania. The 58 patients were divided into five groups: group 1-bone marrow purged, no filgrastim therapy; group 2-bone marrow not purged, no filgrastim therapy; group 3-bone marrow purged, filgrastim therapy after ABMT; group 4-bone marrow not purged, filgrastim therapy after ABMT; and group 5-peripheral blood stem cells (PBSCs) given, followed by filgrastim therapy. The groups were compared for total length of stay (LOS), number of days the absolute neutrophil count (ANC) was < 500/cu mm, total number of days of filgrastim therapy, and total number of cumulative unit days of antimicrobial use. Total LOS was shorter for patients who received filgrastim (groups 3-5) than for patients who did not. Filgrastim was associated with fewer days of ANC < 500/cu mm in groups 4 and 5. The total number of cumulative unit days of antimicrobial use was lower in filgrastim recipients. Patients who received PBSCs needed fewer days of filgrastim therapy than the other filgrastim recipients. The health insurance company determined that, as a result of filgrastim therapy and PBSC transplantation, ABMT costs to the company have dropped by more than 50% since 1990. Patients now have available an alternative to conventional therapy for metastatic breast cancer without prejudice or penalty from their payer.

The impact of lifestyle health risk on the bottom line: a case study.

As the Lifestyle Advantage study continues, HPS expects to follow the utilization trends for a consistent group of participants and nonparticipants, maintaining full confidentiality. Several key issues will be addressed in the process: As the participation rate increases, will the claims payment gap between participants and nonparticipants be reduced? Can a company hope to see a return on an investment in a health promotion program? If so, over what period of time? Finding answers to these questions will contribute to the larger issues of long-term health care cost containment and health care reform.

Developing an in-house physician advisor program.

The rapid rise in health care costs during the 1980s has led to a growing demand for utilization management companies, supported by teams of physician advisors. The increasing involvement of physician advisors in day-to-day case review has also led to a growing necessity for their being hired on an in-house basis. This article attempts to show a basic process for developing a functional and efficient in-house physician advisor program.

A managed care approach to outpatient review.

The recent growth in outpatient services has been the result of both increased use of new and improved technology, along with a shift to an ambulatory setting for many previously performed inpatient tests and procedures. Employers have seen an almost unchecked rapid growth in this portion of health care costs, with no signs of slowing down. This article attempts to show a basic step-by-step approach to identifying and reviewing some of the major cost generators through a managed care program.

Development of an outpatient utilization review program.

Usage of outpatient services has reached an all time high. Insurers and employers seek means to monitor the escalating costs for providing ambulatory care. This article offers insight about the objectives of managed care groups and what they are looking for in their outpatient utilization review endeavors.