The impact of the Integrated Oncological Decision-Making Model (IODM) on healthcare costs and health outcomes in older patients with lower gastrointestinal tumors.

INTRODUCTION

The need to transition towards Value-based Healthcare (VBHC) is becoming more apparent in the Dutch healthcare system. The Integrated Oncological Decision-making Model (IODM) extracts more value from oncological treatment and has shown to alter treatment recommendations towards less invasive treatment modalities without compromising one-year all-cause mortality. However, the impact of IODM on costs remains unclear.

MATERIAL AND

METHODS

This retrospective cohort study involved patients with lower gastrointestinal tumors treated at the University Medical Centre Groningen (2014-2016). Treatment decisions were supported by the IODM. Patients were stratified into two groups: a modified cohort (N = 24) in which the IODM led to an altered and an unmodified treatment advice (N = 44). Outcomes were in-hospital costs within 1-year post-decision making, one- and five-year all-cause mortality and hospital days. Cost data were available for 65 patients and analyzed using nonparametric bootstrap followed by an independent t-test. All-cause mortality was compared between cohorts using a Log-Rank test, while hospital days were analyzed using an independent t-test.

RESULTS

The mean healthcare costs in the first year after clinical decision-making were €13,901 per patient versus €25,213 in the unmodified cohort (observed difference, €11,312; 44.9% lower; p = 0.011). The estimated counterfactual cost difference for the combined cohort was €260,176 (15.9% lower, 95% CI 65,780; 456,780). Costs were significantly lower in the modified cohort for Surgery (p = 0.029); In-patient clinic (p = 0.024); Intensive Care Unit (ICU) (p = 0.012); paramedical (p = 0.015); and laboratorial (p = 0.032). There was no significant difference in one-year and five-year all-cause mortality. However, the modified cohort spent 10 days less in hospital (p = 0.027).

CONCLUSIONS

Modified treatment advice through the IODM was associated with €260,176 lower estimated total healthcare costs in the combined cohort (15.9% lower), a shorter length of hospital stay, and no difference in survival between the two groups.