COMPARISON OF COSTS FOR INFUSION VERSUS BOLUS CHEMOTHERAPY ADMINISTRATION .2. USE OF CHARGES VERSUS REIMBURSEMENT FOR COST BASIS

BACKGROUND. The cost of infusion versus bolus administration of chemot herapy has been a point of controversy as has been the method of quant itating the cost. The present study analyzes the reimbursement for che motherapy administration by infusion compared with bolus delivery base d on reimbursement and relates this to cost based on projected charges and actual charges in a private practice setting. METHODS, Actual rei mbursement records were retrieved for selected patients receiving infu sion or bolus administration of specific chemotherapy regimens for thr ee tumors: colon carcinoma, breast carcinoma, and lymphoma. All servic es were included except for radiology and hospitalization. Medicare re imbursement represented 90% of the treatment cycles analyzed. RESULTS, Actual reimbursement per month for each infusion regimen was as follo ws: colon carcinoma, $528 (5-fluorouracil [5-FU]); breast carcinoma, $ 621 (doxorubicin and cyclophosphamide [AC]) and $685 (cyclophosphamide , methotrexate, and fluorouracil [CMF]); and lymphoma, $603 (cyclophos phamide, doxorubicin, vincristine, and prednisone [CHOP]). Actual reim bursement per month for a bolus regimen was colon carcinoma, $393 (5-F U + leucovorin); breast carcinoma, $991 (AC) or $453 (CMF); and lympho ma, $749 (CHOP). Actual reimbursement represents 21-36% of actual char ges. Projected charges based on the model system are generally less th an the actual charges. CONCLUSIONS. The cost of chemotherapy as define d by reimbursement are substantially less than actual charges and are also less than projected costs based on charges. Data comparing bolus versus infusion reimbursement costs for colon carcinoma, breast carcin oma, and lymphoma indicate that differences between reimbursement for bolus and infusion administration are not substantial. (C) 1996 Americ an Cancer Society.