This news release describes the cost savings and safety of home infusion services from 13 previously published studies compared with infusion services at a clinic or hospital. Home infusion appears safe and clinically effective while saving money in the studies reviewed, but the release does not address limits in the review. We aren’t given any numbers to back up the claims that clinical outcomes were equal and that patients preferred the home setting. The release notes that CVS has a home infusion business–Coram–so at least they make this transparent. We applaud CVS for attempting to quantify the cost savings and other potential benefits of the service — and the claim that there are advantages are likely valid — but some context/background from other, independent studies would be helpful. Besides the lack of quantification, the release doesn’t delve into the potential risks from using the home infusion service.
Treatments for chronic diseases, which often require drugs administered through infusion, are one of the fastest growing costs in the US health care system. If patients can be served at home, rather than in outpatient clinics or hospitals, it saves both money and time. But outcomes studies, which compare outcomes and safety between locations, are essential to judging whether home infusion is equal to clinic or hospital infusion. This release does not go far enough with numbers to quantify benefits and risks. We also see that CVS has a conflict of interest, because they have a business arm, Coram, that sells home infusion services. It appears this release (and study) are getting attention just as Congress is “discussing how to implement a comprehensive home infusion benefit for Medicare beneficiaries.”
The news release includes information about costs. We would have liked a little more context. The release states: “The costs associated with home infusion were also consistently lower than services provided in a health care facility, with savings ranging between $1,928 and $2,974 per course of treatment.”
We need to know what percentage of savings that is per course of treatment. If the whole course costs $100,000, then saving $1,928 is a pretty small percentage. If the whole course is $10,000, than a savings of $1,928 looks more substantial.
We found the news release skimmed over giving crucial numbers and metrics for benefits. Separate from the cost benefit to home infusion versus hospital or clinic infusion, the release should have given us some numbers for safety.
Here is what the release stated (emphasis ours):
“The research showed that patients receiving intravenous therapy at home had as good or better clinical outcomes as those patients who received the same therapy in a traditional health care setting. In addition, patients overwhelmingly preferred receiving their infusion therapies at home, reporting fewer disruptions in personal schedules and responsibilities.
We need numbers to demonstrate how “as good” the clinical outcomes were. We need numbers to represent “overwhelmingly preferred.” By what percentage did what number of patients demonstrate preference?
This is where the release could have taken some quantitative data from the study.
The word “harms” does not appear in the news release. During intravenous infusions there are complications that may arise. The release does not mention harm, even to dismiss the probability as rare.
The study being reported is a systematic literature review that only considered 13 prior studies. The release does not address the limitations of a literature review or give us the total number of patients represented by the 13 studies.
Only 5 of the 13 studies used in the analysis addressed outcomes. One had no comparison group (“However, no adjustment for confounders was performed, and higher OPAT success rates were likely due to purposeful selection of younger, healthier patients for OPAT therapy,” according to the published study). In another study, “IPAT patients were selected from a time period during which OPAT was not available for any patients, minimizing selection bias by the matching fact.”
In any case, less than half of the studies looked at outcome data and those that did involved different diseases from different time periods, some had control groups and some did not. We don’t think the evidence is strong enough to suggest outcomes were improved.
The bias inherent in CVS employees culling the studies is also concerning. A better description of the review’s search and selection process may have helped allay any concerns about studies being cherry-picked.
There is no disease mongering.
The release is clear that the study was done by the CVS Health Research Institute. Since this is a news release from a profit-making company that operates directly to sell services under study, we hope the readers quickly understand there is an inherent conflict. This is the equivalent of a Coca Cola study about the benefits of drinking their product.
The release explains the alternatives of clinic or hospital infusion compared to home infusion.
Home infusion services are widely available. Their reimbursement is not widely available.
The release says “clinical outcomes and quality of care have not previously been systematically evaluated.”
The release doesn’t rely on any unreasonable or unjustified language. However, we do not think the news release proves the words used in the headline that say “Home Infusion Care Improves Patient Outcomes and Quality of Life While Reducing Overall Costs.”
Based on a literature review, which does not randomize people into apples-to-apples comparison, you cannot claim to show better outcomes. The release does not offer any quantified benefits to support medical outcomes and doesn’t provide quantified information about quality of life improvement. The fact that patients prefer home infusion to travel to a clinic is not by itself a proof that their lives have been improved. As we wrote in the benefits section above — we are not given numbers to prove by what amount patients prefer home infusion.