Alternative Sites of Care Lower Infusion Costs Without Compromising Outcomes
Key Clinical Summary
- In a matched cohort of 52 760 infusions, hospital outpatient department (HOPD) administration was associated with approximately 42% higher outpatient costs compared with alternative sites of care (SOCs).
- No significant differences were observed in short-term adverse events, emergency department visits, or overall utilization between HOPDs and SOCs.
- Infusion adherence at 12 months was similar across settings, supporting SOC expansion as a cost-containment strategy without quality trade-offs.
Infusion therapy for chronic diseases is increasingly delivered across multiple care settings, raising questions about cost and quality differences between HOPDs and alternative SOCs. New real-world evidence suggests that SOCs—including physician offices, ambulatory infusion centers, and home settings—may offer comparable clinical outcomes at substantially lower cost.
Study Findings
This retrospective matched cohort study analyzed 52 760 infusions among 18 988 commercially insured patients across the US between 2022 and 2023. Infusions across 23 biologic agents used for 7 chronic conditions—including rheumatoid arthritis, multiple sclerosis, inflammatory bowel disease, and osteoporosis—were evaluated.
After propensity score matching, outcomes were compared between 26 380 HOPD infusions and an equal number of infusions delivered in alternative SOCs.
Within 1 day postinfusion, there were no significant differences between HOPDs and SOCs in emergency department visits, inpatient admissions, or adverse events. Results remained largely consistent at 7 days postinfusion, although HOPD-treated patients had higher odds of inpatient admission (odds ratio, 1.45; P < .05) and lower odds of filling a prescription (odds ratio, 0.91; P < .01).
Cost differences were substantial. HOPD infusions were associated with 41.9% higher outpatient costs within 1 day and 41.5% higher outpatient costs within 7 days. Total costs were similarly elevated, with approximately 40% higher spending compared with SOCs. Infusion claim costs were also about 42% higher in HOPDs.
Adherence outcomes, measured in a subset of 410 patients over 12 months, showed no statistically significant differences between settings, indicating similar treatment continuity regardless of SOC.
Clinical Implications
For managed care organizations, these findings reinforce the economic value of shifting appropriate infusion therapies to lower-cost settings. Despite significantly higher costs, HOPDs did not demonstrate improved safety, reduced utilization, or better adherence outcomes compared with SOCs.
These results support payer strategies that assess medical necessity for HOPD use and encourage SOC optimization programs. Such programs may include prior authorization requirements, care navigation, or benefit design incentives to steer patients toward ambulatory or home-based infusion settings when clinically appropriate.
Importantly, the study suggests that cost savings do not come at the expense of patient safety or quality, which has been a longstanding concern in SOC transitions. The comparable adverse event rates and utilization outcomes observed across settings strengthen the case for broader SOC adoption.
Conclusion
Infusion therapy delivered in alternative SOCs achieves comparable clinical outcomes at significantly lower cost than hospital outpatient departments. For payers and health systems, expanding access to SOCs represents a key opportunity to improve value while maintaining high-quality care across chronic disease populations.
Reference
Cullen D, Gordon AS, Svoboda SA, Alvarez M, Cobb R. Infusion therapy patient outcomes are similar at reduced costs in alternative sites of care compared with hospital outpatient departments: A matched cohort analysis of infusion therapy across multiple chronic conditions. JMCP. 2025;32(3). doi:10.18553/jmcp.2025.25264
