Cost of care associated with utilization of telehealth in clinical trials

Objective

Due to COVID-19 pandemic restrictions, telehealth was incorporated into standard oncologic care and clinical trial operations. We sought to analyze whether telehealth changed cost of care compared to traditional clinical trial operations.

Methods

We conducted a retrospective cohort study of gynecologic oncology patients enrolled in therapeutic clinical trials at a National Cancer Institute designated center, comparing the cost of cancer care on trial pre-TELEhealth (9/30/2019 to 3/15/2020) versus during TELEhealth (3/16/2020 to 8/20/2020). Inclusion required trial participation during both study periods, ≥1 telehealth visit, and identifiable billing records. The analysis was from a healthcare sector perspective. Cost per patient per month on trial was calculated for scheduled (per protocol) and unscheduled (non-protocol) encounters using 2020 national Medicare reimbursement rates, not institution-specific prices. Pairwise t-tests between pre-TELE and TELE periods were performed.

Results

Twenty-eight patients were included in the study. The majority of patients (93 %) had ovarian cancer. One patient (4 %) had uterine and 1 (4 %) had concurrent ovarian/uterine cancer. Most patients had advanced-stage disease at diagnosis (93 %). Mean cost per patient per month was similar in pre-TELE and TELE periods ($3797 vs. $4720, p = 0.064). There were no cost differences among scheduled or unscheduled encounters, office or ED visits, admissions, outpatient procedures, nor those billed to study sponsors or patient’s insurer.

Conclusions

Incorporating telehealth in gynecologic cancer clinical trials during the COVID-19 pandemic did not increase cost of care and may be a mechanism for decentralizing clinical trials, reducing barriers to trial participation, and improving the value of cancer care.