Infusion Therapy Access Improves Through Patient Programs Aiding Care and Easing Cost Strain
The cost of infused and injectable therapies is prompting plan sponsors to seek strategies to reduce expenses while maintaining quality of care, with a growing focus on optimizing where patients receive treatment. A recent study assessing patient outcomes found that infusions administered in hospital outpatient departments (HOPDs) carry higher costs without demonstrably improving patient outcomes compared to alternative settings.
These alternative settings include ambulatory infusion centers (AICs), physician offices, and even patients’ homes. The study, published in JMCP and PubMed, matched patients receiving infusions in HOPDs with those receiving care in these other settings, controlling for factors like the specific infusion agent, treated disease, and patient demographics. Researchers found no significant differences in all-cause costs, utilization of inpatient, emergency department, or pharmacy services, or rates of adverse events between the groups. Infusion therapy adherence as well remained consistent across settings.
The findings highlight a significant cost disparity. HOPDs, while offering a familiar environment for some patients, do not appear to deliver superior clinical results. This realization is driving payers and vendors to implement “site-of-care optimization” programs. These programs aim to direct patients to lower-cost infusion locations, coordinating care and managing drug distribution to maximize savings.
The shift towards lower-cost settings is also supported by demographic trends. The number of Americans aged 65 and over is projected to increase substantially by 2040, creating greater demand for infusion therapies and intensifying the necessitate for cost-effective delivery models. Moving infusions out of hospitals and into more accessible, less expensive locations, such as physician offices or patients’ homes, is seen as a key strategy to manage these rising costs.
Outpatient infusion therapies, unlike self-administered injectables like insulin, require healthcare professionals due to the complexity of preparation, potential for adverse reactions, and the need for specific administration routes – intravenous, intradermal, or intramuscular. The variety of clinical environments offering these services – hospital outpatient departments, physician office infusion centers, ambulatory infusion centers, ambulatory infusion sites, and home infusion therapy – each present different fee structures and cost implications.
While the study indicates comparable outcomes across settings, the choice of location can still be medically necessary in certain cases. The research specifically excluded instances where a HOPD was deemed medically essential, suggesting that the cost savings are most significant when alternative settings are appropriate for the patient’s condition.
Major payers are increasingly offering specialty pharmacy programs alongside site-of-care optimization, further streamlining the process and directing members to the most appropriate and affordable infusion locations. The trend suggests a broader industry effort to balance cost containment with quality patient care in the rapidly evolving landscape of infused and injectable therapies.
