Financial Incentives May Contribute to Extended Maintenance Therapy in Community Settings


Receiving care in a community setting is associated with a prolonged maintenance treatment in patients with non-Hodgkin lymphoma, according to a study presented at the American Society of Hematology (ASH) annual meeting (December 8-12, 2017; Atlanta, GA).

Researchers suspect financial incentives may contribute to the guideline-discordant use of maintenance rituximab.

“Providers practicing in the physician-office setting are more likely to derive income directly from chemotherapy administration compared to hospital-employed physicians,” researcher Scott Huntington, MD, MPH, said in an interview (December 4, 2017). “Prior research suggests physicians in community settings are more responsive to reimbursement changes in their choice of chemotherapy regimens compared to hospital-employed providers.”

Although maintenance rituximab has been shown to improve progression-free survival in some lymphoma settings, current guidelines do no support more than 2 years of maintenance, researchers explained.

To compare the rate of prolonged rituximab maintenance treatment in community versus hospital-based settings, researchers looked at 2620 Medicare patients with B-cell non-Hodgkin lymphoma with more than 2 years of available follow up after initiation of maintenance rituximab.

Approximately 75% of the patients in the study received maintenance rituximab in community settings. Among all patients in the study, the median number of rituximab maintenance doses was nine, and the mediation duration of maintenance was 14 months. Ten percent of patients overall received rituximab maintenance for more than 2 years.


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Treatment in community settings, however, was significantly linked with more than 2 years of rituximab maintenance treatment and more than 12 doses of rituximab monotherapy. Approximately 11% of patients receiving care in community-based settings received more than 2 years of maintenance rituximab, researchers found, compared with 6.9% of patients receiving care in hospital-based settings.

“Since financial incentives in the community setting are more likely to be strongly tied to administration of anti-cancer therapies, our findings suggest financial incentives may contribute to overutilization during rituximab maintenance,” researchers concluded.—Jolynn Tumolo