Assessing the impact of bundled payments on quality and cost of cancer treatments: A systematic review

BACKGROUND: Cancer care is often fragmented, leading to poor quality, unnecessary duplication, and higher costs from low-value services. These problems are common across chronic and complex conditions, where patient-centred approaches are essential. Bundled payments, where single payments covering all services in an episode of care, have been proposed as a way to address these problems: improving both efficiency and quality. However, their impact on quality and costs in oncology remains unclear. OBJECTIVES: Estimate the impact of bundled payments in oncology on costs, quality and patient outcomes. METHODS: We conducted a comprehensive search strategy in PubMed and Embase to identify all articles that assessed bundled payments in cancer care in the last 5 years. The Cochrane Collaboration Effective Practice and Organisation of Care (EPOC) framework was used to assess for risk of bias. RESULTS: Eighteen studies met the inclusion criteria for the systematic review. Overall, evidence on the impact of bundled payments in oncology is limited. Few high-quality studies were identified, all from the United States, and none examined a mandatory bundled payment scheme. Across these studies, there was no consistent evidence of improvements in either costs or quality of care. DISCUSSION: The predominance of voluntary U.S. programs substantially limits the generalisability of findings to other health systems. Policymakers in other high-income settings should therefore be cautious in extrapolating these findings and should prioritise context-specific piloting and evaluation to identify what works, under what circumstances, and why, before large-scale implementation of bundled payments.