Background: Chemotherapy administered near the EOL is associated with higher costs due to downstream care that occurs when patients do not transition to hospice, such as hospitalizations and ICU use. Since 2015 rates of systemic therapy at the EOL have remained stable, while chemotherapy has been replaced with costly immunotherapy. Recently, we showed receipt of immunotherapy at the EOL is also associated with higher rates of acute care use than among patients who don’t receive by SACT near the EOL. Using data from practices participating in OCM, we evaluated the relationship between receipt of chemotherapy, immunotherapy, or no systemic therapy at the EOL and categories of cost. Methods: We used anonymized Integra Connect data for OCM episode claims attributed to 8 multi-site OCM practices from July 2016-December 2021 to identify decedents capable of making treatment decisions. We stratified patients by SACT type received within 30 days of death (immunotherapy (IO), chemotherapy (CT), or none) and used t-tests to compare the mean episode costs. We evaluated differences in overall costs as well as those billed under Medicare subgroups: Part A, inpatient acute care use and other services including (hospice, SNF, HHA), Part B, infusion drug administered in the ambulatory setting and medical and ED costs, and Part D, oral pharmacy costs. Results: Among 14,169 OCM decedents overall mean cost within 30 days of death was $22,215. Overall cost within 30 days of death was higher for patients receiving some form of SACT (IO: $26,072 or CT: $23,259) compared with no SACT $19,296 (table) all p < 0.01). Patients who received no SACT at EOL had significantly lower Part B and D compared with both IO and CT respectively (all p < 0.01). Additionally, patients who received CT had lower average part B costs $8,081 compared with patients who received IO within 30 days of death $13,951 p < 0.01. Conclusions: Overall costs for patients who received IO or CT within 30 days of death were significantly higher than patients who received no SACT within 30 days of death. While IO patients had nearly twice as high mean Part B costs per episode compared with CT patients, CT patients had higher mean Part D costs per episode. Further research should explore whether these findings are generalizable to patients outside of OCM.

1: Significant p-value for differences reported: §IO and CT < 0.05; *IO and No SACT < 0.05; ΦCT and No SACT < 0.05.