Unpacking cost of care: Contributors to total cost of care in oncology episodes.

22 Background: The Enhancing Oncology Model (EOM) is a value-based care (VBC) initiative that evaluates physician group practices (PGPs) based on total cost of care (TCOC) for 6-month cancer care episodes involving systemic anti-cancer therapies (SACT) across seven cancer types. As oncology treatment regimens grow more complex, identifying the key cost drivers within these episodes is essential for optimizing performance under VBC models. This study aims to quantify the components contributing to TCOC and inform strategies for care redesign and cost containment. Methods: We conducted a retrospective analysis of EOM performance period claims and episode data from a large, multi-state, community-based oncology network (July 2023–June 2024). TCOC was stratified by cost domains: systemic therapy (oral and injectable), acute care utilization (ED visits and hospitalizations), hospice services, diagnostics, procedures, and supportive care, across the seven EOM cancer types. Results: Among 2,000 episodes, the average TCOC per 6-month episode was $59,220. SACT accounted for 72% of TCOC—26% from oral and 46% from injectable therapies. Inpatient utilization contributed 8% (hospitalizations 7%), with smaller shares from ED services, diagnostics, and end-of-life care. Conclusions: SACT—especially injectable and oral drugs—account for nearly three-quarters of TCOC. However, cost drivers differ significantly by cancer type, with oral therapies playing a major role in chronic leukemia, multiple myeloma, and prostate cancer. Inpatient care, though a smaller share of TCOC, remains a key non-treatment cost, particularly in colorectal and lymphoma episodes. These findings highlight the need for cancer-type-specific strategies in value-based care, including targeted interventions in drug management (including treatment pathways, therapeutic substitution programs, utilization management, etc.), acute care (hospitalization & ED) reduction, and supportive care (symptom management, end-of-life-care, survivorship, care management, etc.) optimization. Future models should adopt nuanced cost attribution frameworks that reflect the full complexity of oncology care delivery. TCOC contributions by cancer type. Cancer Type Per Episode TCOC Part B Drugs Part D Drugs Inpatient Outpatient & Physician Services Radiation Therapy All Other Breast Cancer $46,417 46% 22% 7% 12% 2% 10% Chronic Leukemia $63,110 12% 72% 6% 5% <1% 4% Colorectal Cancer $42,825 43% 10% 13% 15% 2% 17% Lung Cancer $72,915 65% 6% 9% 8% 3% 9% Lymphoma $43,046 49% 21% 11% 11% <1% 8% Multiple Myeloma $94,518 44% 41% 5% 5% <1% 4% Prostate Cancer $50,012 22% 41% 6% 21% 1% 9% All Episodes $59,220 46% 26% 8% 10% 2% 8%