Name
#123 Assessing Value Differences in Malignant Brain and Other Central Nervous System Tumor Treatment Across Care Settings in the U.S. Military Health System
Speakers
Content Presented On Behalf Of:
Uniformed Services University
Services/Agencies represented
US Navy
Session Type
Poster
Date
Tuesday, March 3, 2026
Start Time
5:00 PM
End Time
7:00 PM
Location
Prince Georges Expo Hall E
Focus Areas/Topics
Clinical Care, Policy/Management/Administrative
Learning Outcomes
1) Describe the treatment cost and mortality burden of central nervous system cancer in the U.S. and relevance to the DoD population.
2) Compare treatment cost and clinical outcomes in the MHS direct and private networks for patients with central nervous system cancers.
3) Examine the value of care across the MHS direct and private networks for central nervous system cancers and articulate how referral management processes may benefit from this analysis.
2) Compare treatment cost and clinical outcomes in the MHS direct and private networks for patients with central nervous system cancers.
3) Examine the value of care across the MHS direct and private networks for central nervous system cancers and articulate how referral management processes may benefit from this analysis.
Session Currently Live
Description
Background: Malignant brain and other central nervous system tumors (MBT) disproportionately affect men and women in the age range of active-duty service members. MBT are deadly and costly to treat, with five-year survival at 33% and per-patient treatment exceeding $200,000. Thus, understanding the value of MBT treatment may have implications as the MHS works to field a medically ready combat force and ready medical care teams. We aimed to assess differences in clinical outcomes and the value of MBT care between the Direct Care (DC) and Private Sector Care (PSC) settings of the U.S. Military Health System (MHS).
Methods: Linked cancer registry and administrative claims data from the MilCanEpi database including 574 patients aged 18 to 64 diagnosed with MBT between 2003 and 2014 was used to examine clinical outcomes in each setting. Total cost per patient was based on 2022 adjusted costs in US dollars (USD) for primary treatment delivered in the first six months after diagnosis. Survival analyses examined differences in event-free survival and the instantaneous rate of recurrence, second course of treatment, or all-cause death within 18 months of initial treatment across care settings. Value, as the between-setting (PSC vs. DC) instantaneous rate of clinical outcomes per thousand USD of treatment costs, was estimated using linear and non-linear Cox models combined with restricted cubic splines as adjusted hazard ratios (aHR) and 95% confidence intervals (CI).
Results: Cox model estimates suggested no significant associations between care setting (PSC vs. DC) and any outcome (aHR: 0.99, 95% CI [0.79,1.24], p=0.91) or death (aHR: 0.72, 95% CI [0.50,1.03], p=0.07). Patients with total treatment costs below the median had a higher instantaneous rate of any outcome per $1,000 in treatment in PSC versus DC, although patients with total treatment costs above the median had a lower instantaneous rate of any outcome per $1,000 in treatment in PSC compared to DC. Compared to DC, patients in PSC with costs near the 10th percentile of total treatment costs had a 22% higher rate (aHR: 1.22, 95% CI [1.06,1.40], p=0.006), and patients near the 25th percentile had a 15% higher rate of any outcome per $1,000 in treatment (aHR: 1.15, 95% CI [1.04,1.27], p=0.005). However, compared to DC, patients in PSC with treatment costs near the 75th percentile had a 24% lower rate (aHR: 0.76, 95% CI [0.63,0.91], p=0.004) and patients in PSC near the 80th percentile had a 35% lower rate of any outcome per $1,000 in treatment (aHR: 0.65, 95% CI [0.49,0.86], p=0.003).
Conclusions: While we found the rate of clinical outcomes to be similar for MBT treatment across care settings of the MHS, the value of care differed in DC compared to PSC. Patients with treatment costs below the median received higher value care in DC, while patients with treatment costs above the median received higher value care in PSC. When clinically appropriate, referring patients with higher MBT treatment utilization to PSC and retaining patients with lower MBT treatment utilization in DC may help maximize value within the MHS.