Size, Location, Affiliation of Practice Impact Immunotherapy Adoption Rates

According to an analysis of Medicare fee-for- service beneficiaries treated with chemotherapy between 2010 and 2017, the speed at which immunotherapy is adopted by oncology practices depends on their size, location, and affiliation (rural or urban, independent or health system–affiliated, academic or nonacademic, smaller or larger [1 to 5 physicians vs 6 or more]).¹

Investigators analyzed 71,659 chemotherapy episodes compiled from 1732 oncology practices, 264 (15%) of which were located in a rural area, 900 (52%) of which were independent, and 492 (28%) of which had 1 to 5 physicians. Immunotherapy had been adopted within 2 years of FDA approval, but researchers found a wide variation in adoption rates.

“Adoption tends to be slow and uneven across different practices or different geographic areas,” lead author Caitlin E. Carroll, PhD, assistant professor, Division of Health Policy & Management, University of Minnesota School of Public Health, in Minneapolis, said during an interview with Targeted Therapies in Oncology.

“This is important…because the adoption of novel therapies…is a key driver of improvements in life expectancy.”

Specifically, rural and small practices were slower to adopt immunotherapy, as were independent practices and those not affiliated with an academic system; however, rural and small practices had lower adoption rates than practices that were affiliated with academic systems.

Investigators reviewed the records of patients with kidney, lung, head and neck cancer, and melanoma.

“We see differences in adoption patterns across different types of practices, but the adoption curve[s] for these practice types, such as between urban practices and rural practices, are similar in shape,” Carroll explained, adding that “once rural practices became familiar with immunotherapies, their adoption rates were similar to [those of] urban practices.”

Reasons for Delay

When asked whether the delays might be attributable to reimbursement or coding difficulties, Carroll said that “smaller…or rural practices might have less opportunity to negotiate discounts on drug prices, but we can’t observe that based on the data.”

Another reason could be lack of expertise or information. “There’s concern,” she noted, “that oncologists in rural areas might have less specialized expertise or…less access to clinical trials. They don’t have the same sort of information exchange you see at an academic system. And these [challenges] could slow down adoption.”

Next Research Steps

The current study did not compare adoption rates to insurance type, but Carroll thinks that relationship will be examined next.

“It would be useful to understand the different costs and benefits for providers when they think about adopting a new therapy such as immunotherapy,” she said. How does a clinician determine the cost-benefit ratio? “It’s an important question to explore moving forward.”

Although the cost may be relatively low, “we still see differences in adoption patterns across different clinical practice types, which suggests that there’s something other than clinical need that’s driving treatment decisions,” Carroll concluded.

REFERENCE:

1. Carroll CE, Landrum MB, Wright AA, Keating NL. Adoption of innovative therapies across oncology practices-evidence from immunotherapy. JAMA Oncol. 2023;9(3):324333. doi:10.1001/jamaoncol.2022.6296