For private health plans, cancer care is a growing expense that extends far beyond drug costs. Infusion visits, emergency department (ED) use, hospitalizations, and care facility infrastructure all drive up total spending.
A 2022 analysis of privately insured, nonelderly adults with breast, colorectal, lung, and prostate cancers found that average total costs in the first year after diagnosis were substantial and increased over time. From 2009 to 2016, average costs increased 29% for breast cancer and 11% for lung cancer. The study also found a rise in the use and costs of intravenous (IV) systemic therapy and other cancer-related services, highlighting the range of costs that contribute to the total cost of cancer care.
While payors have limited leverage over drug pricing, they may have influence over where and how supportive care is delivered. For selected patients, moving supportive oncology infusions from a facility setting to home care maintains clinical oversight and patient comfort while helping to control costs.
An Overlooked Cost Driver: Supportive Care, Not Just Chemotherapy
Cancer cost-containment strategies often focus on chemotherapy, immunotherapy, and other high-cost medications. But the care surrounding those treatments can also contribute substantially to overall cancer care costs. Supportive oncology care addresses the symptoms and complications that occur during cancer treatment. It can include pain management, hydration, and treatment of anemia, among other interventions designed to keep patients stable and help them continue their prescribed treatment plan.
In a 2024 analysis of commercially insured patients, chemotherapy-induced febrile neutropenia was associated with an average cost of $25,176 per episode, with costs increasing when hospitalization occurred. Additional data from working-age adults with private insurance similarly show that most cancer-related spending occurs through medical care rather than pharmacy spending.
Some supportive treatments are well-suited to home infusion because they don’t require the same level of infrastructure as many cancer-directed therapies. When clinically appropriate and ordered by the treating provider, skilled nursing delivered by a registered nurse (RN) trained for these type of infusions can administer therapy, monitor the patient, and communicate changes to the cancer team without requiring the patient to travel to a hospital or infusion center.
That matters for payors. A hospital outpatient department or infusion center requires physical space, staffing, and other infrastructure to support each encounter. Patients also face additional costs through transportation, time away from work, caregiver coordination, and repeated trips to a medical facility.
The opportunity isn’t to move every oncology service into the home. It’s to identify certain health condition supportive services for which the home is a clinically appropriate and economically rational site of care.
Clinical Use Cases for Home Infusion Delivery
Two specific supportive oncology services illustrate where this strategy can have practical value: IV pain management and IV iron for chemotherapy-induced anemia.
IV Pain Management
Cancer-related pain is a significant source of health care utilization, particularly for patients undergoing active treatment or living with advanced disease. A 2023 analysis of more than 35 million ED visits among patients with cancer in the U.S. found that 51.6% of those may have been preventable. Pain was the most common reason for these visits, and cancer-related ED visits for pain more than doubled during the study period.
Not every ED visit is avoidable, but proactive management of cancer-related symptoms may provide an opportunity to intervene before symptoms become unmanageable. For appropriate patients, physician-directed supportive treatment delivered at home by an infusion-trained RN can provide symptom assessment, prescribed therapy, and communication with the oncology team.
The goal is to create an additional site of care for cancer-related supportive treatments that can be safely managed outside the hospital, potentially reducing pain for the patient and any unnecessary ED visits and the associated costs.
IV Iron for Chemotherapy-Induced Anemia
Anemia is common during cancer treatment and can contribute to fatigue, reduced quality of life, and additional health care needs. For patients with chemotherapy-associated anemia who are appropriate candidates for iron replacement, IV iron can improve hemoglobin levels and may reduce the need for RBC transfusions. One review found that IV iron generally improved hemoglobin and reduced transfusion rates across multiple cancer-treatment settings.
For payors, anemia management also presents an opportunity to consider site of care. When clinically appropriate and ordered by the treating provider, a qualified RN can administer IV iron in the home, eliminating another trip to an infusion center while maintaining clinical monitoring.
Again, this isn’t to replace transfusion or acute care when they are medically necessary. Instead, home-based IV iron can provide an additional site of care for selected patients who can safely receive supportive treatment outside a hospital or infusion center.
The ROI of Moving Supportive Oncology Care Home
The financial case for home-based supportive infusion care goes beyond the cost of a single nursing visit. Payors should evaluate the effect on the member’s total episode of care.
Avoiding Preventable ED Visits
Cancer patients frequently present to the ED with symptoms that require timely assessment. In a previously mentioned study, more than half of ED visits among patients with cancer were classified as potentially preventable, with pain the leading cause of the visits.
This creates an opportunity for payors to consider whether earlier outpatient and home-based interventions can address distressing symptoms before they escalate.
The question isn’t just “What does a home infusion visit cost?” The question is “What higher costs can at-home infusions replace?”
Reducing Facility & Overhead Costs
The math of home infusion is straightforward: The medication and supplies cost the same regardless of location. A key difference-maker is site overhead.
Hospital outpatient departments and infusion centers require physical space, staff, and other infrastructure to support care.
With home infusion, a qualified nurse brings the clinical service directly to the patient. This unbundles oncology costs into the essential components: the medication, the equipment, and the nurse’s time.
The exact economics will vary by therapy, patient population, geography, reimbursement structure, and the alternative site of care. For that reason, payors should evaluate home infusion based on actual utilization and cost data rather than assume every infusion will produce the same level of savings.
Lowering Transfusion-Related Costs
When clinically appropriate, reducing the need for RBC transfusions may create another potential source of cost savings. Using IV iron administration when appropriate has been associated with higher hemoglobin levels and lower transfusion rates across several cancer-treatment settings.
For patients with cancer-related or chemotherapy-associated anemia, effective anemia management may help reduce downstream utilization. However, the choice of IV iron, RBC transfusion, or another anemia treatment should remain individualized and based on the patient’s clinical status and treating provider’s treatment plan.
Payors should ask whether proactive anemia management can improve patient outcomes and reduce the need for higher-cost downstream services when clinically appropriate. While the evidence supports the potential for anemia treatment to reduce transfusion requirements, the economic impact will depend on the patient population, treatment strategy, site of care, and other factors.
Protecting Patients From Unnecessary Facility Exposure
Cancer patients might be particularly vulnerable to infection and other complications during treatment. Eliminating an unnecessary trip to a busy medical facility can reduce exposure to germs and ease the physical burden of travel. This can be especially meaningful for older patients, those who have multiple comorbidities, or people experiencing treatment-related fatigue.
Home infusion is only appropriate when it can maintain the same caliber of clinical oversight. The right model replaces a facility visit with one-on-one RN care in the patient’s home.
Improving the Member Experience
Making cancer care easier to navigate also adds value. A 2024 review found that home-based supportive care programs, including home nursing, patient and caregiver education, telephone support, and other services, were associated with improved quality of life in several studies. Improvements included social and emotional functioning.
For payors, the patient experience is also important. Receiving appropriate supportive treatment at home may reduce the time and logistical burden associated with traveling to an infusion center, potentially helping patients maintain work, family responsibilities, and daily routines.
What Payors Should Look For in an Oncology Home Infusion Partner
Moving supportive oncology care into the home requires more than finding a nurse who can start an IV. Payors should evaluate clinical and operational infrastructure because the true value of home infusion depends on reliable execution. Patients must be appropriately identified, orders coordinated, nurses matched to required clinical skills, and treatments delivered according to established protocols.
Here are the key considerations when looking for an oncology home infusion partner:
Nurse-Led Clinical Oversight
Infusions should be administered by appropriately trained RNs working under physician orders and established clinical protocols to ensure the plan of care is executed faithfully in the home.
Clear Safety Standards
The provider should have defined, rigorous processes for monitoring patients, recognizing acute adverse reactions, and escalating concerns to the treating team.
Infusion Competency
Nurses should have relevant experience with vascular access, infusion administration, patient assessment, and emergency responses for managing potential adverse reactions in a home setting.
Care Coordination
The home infusion team should communicate effectively with the oncology practice, specialty pharmacy, and other care team members. Centralized intake, dedicated communication channels, and secure platforms support real-time alignment during home visits.
Consistent Documentation
Clinical records should be updated with a detailed, standardized method after each encounter to support continuity of care, quality monitoring, and seamless communication among providers.
National Reach
Multi-state payors need a partner that can maintain consistent standards across markets rather than creating a different process for every geographic region. A national model can also reduce the operational burden of implementing a home infusion strategy across multiple markets.
The Site of Care Is an Underused Oncology Cost Lever
Cancer spending will continue to challenge private payors, but certain steps for reducing costs often correlate with better patient outcomes. Drug pricing can be difficult for a health plan to influence, but the location and delivery model for appropriate supportive care can be more actionable.
For selected oncology patients, moving supportive infusion services from facility-based settings into the home can reduce facility costs, acute care utilization, and transfusion-related spending while making treatment more convenient for patients.
The goal isn’t simply to move care out of a hospital. It is to put the right care in the right setting, with the clinical oversight necessary to make that transition safe.
For payors looking to expand cancer care at home, a nurse-led home infusion partner can provide the workforce, clinical infrastructure, and geographic reach needed to scale site-of-care optimization.
What BrightStar Care Brings to an Infusion Partnership
BrightStar Care delivers a national, nurse-led home infusion model backed by clinical oversight, standardized quality, and an exclusive partnership with the Infusion Nurses Society to support infusion education and protocols.
In 2025, BrightStar Care nurses performed more than 102,000 infusions across more than 440 locally owned locations in 43 states, while adhering to nationally aligned accreditation standards and audits. Our model supports care coordination, clinical consistency, and optimized total spending.
Ready to evaluate home infusion therapy as part of your oncology cost-containment strategy? Connect with BrightStar Care to discuss how a nurse-led home infusion model can support your members, provider network, and total-cost-of-care goals.