The ADVI Health Strategic Analytics, Value and Economics (SAVEs) Team worked with a US-based biopharmaceutical company to perform a study assessing the use of PD-1 and PD-L1 products for lung cancer episodes within the Enhancing Oncology Model (EOM) to see what influence they may have had on target pricing.

The Challenge

The Enhancing Oncolgy Model (EOM) is a 5-year, voluntary Alternative Payment Model (APM) advanced through the Centers for Medicare and Medicaid Services (CMS), Center for Medicare and Medicaid Innovation (CMMI). It is a total cost of care model, based on a 6-month episode of care, which forces oncology providers to evaluate the relative value of drugs and services within the episode. The EOM is limited to seven cancer types including breast, chronic leukemia, small intestine/colorectal, lung, lymphoma, multiple myeloma, and prostate. The model combines fee-for-service (FFS) payments with two model-specific payment components.

The Strategy 

Using SAVEs access to 100% Medicare FFS data from CY 2016-2020, we replicated CMMI’s EOM methodology to identify lung cancer episodes based on the initiation of chemotherapy and immunotherapy. We attributed beneficiaries to participating physician groups and calculated the total episode cost, target price, and assessed episode metrics of PD-L1 utilization, inpatient hospitalizations, and emergency room use.

The Results 

ADVI SAVEs assessment found that PD-1/PD-L1 were utilized in 53 percent of lung cancer episodes, and the use of various PD-1/PD-L1 products shifted over time. The pharmaceutical company used the results of the assessment to better understand payment dynamics within lung cancer episodes in EOM.

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