A comparison of reimbursement for outpatient intraperitoneal chemotherapy versus intravenous therapy for ovarian cancer

Background: The Gynecologic Oncology Group (GOG) 0172 trial clearly demonstrated that intraperitoneal (IP) chemotherapy produced superior outcomes to intravenous (I.V.) chemotherapy for women with advanced ovarian cancer (AOC). Broad adoption of IP chemotherapy might depend in part on adequate reimbursement. This study evaluates reimbursement for outpatient IP chemotherapy versus I.V. chemotherapy within our marketplace. Patients and Methods: We report on an institutional review board-approved retrospective analysis of 28 women with AOC receiving IP treatments between January 2006 and December 2006. Reimbursement for these IP treatments was compared with that for the former standard I.V. carboplatin and taxane chemotherapy. Fifteen of the 28 patients crossed over from IP to I.V. treatment, thus serving as their own controls. We analyzed medication administration codes, drugs, and supportive care medication. Results: Reimbursement for IP administration was significantly higher than for I.V. administration, with the respective mean billed $4529 for IP versus $1140 for the I.V. route. Reimbursement rates for IP administration ranged from 0 to 100% (median, 98%; mean, 85%). Reimbursement rates for the I.V. administration ranged from 23% to 92% (median, 47%; mean, 49%). Mean total charges for an IP regimen were 1.54 times higher than for the I.V. regimen. Mean reimbursement rates were also higher for IP treatment than for I.V. (54% vs. 31%, respectively). Conclusion: Intraperitoneal chemotherapy for ovarian cancer is more effort-intensive and requires more chemotherapy and supportive care medications, resulting in higher charges and higher revenue when administered on an outpatient basis. When billed according to current guidelines, reimbursement is considerably better for this labor-intensive chemotherapy regimen.