Clinical Pathways Helped Health System Lower Costs, Boost Trial Enrollment Across Multiple Sites

The savings occurred even while more patients in the health system were enrolling in clinical trials, according to an abstract presented during the American Society of Clinical Oncology 2020 Virtual meeting.

The average cost of care for lung cancer patients treated by a Midwest cancer group was nearly $80,000 less than patients in the same health system whose care moved off pathway, according to results presented recently.

The savings occurred even while more patients in the health system were enrolling in clinical trials, according to an abstract presented during the American Society of Clinical Oncology 2020 Virtual meeting.

Results from the Aurora Cancer Group, which operates 19 cancer care sites centered in Milwaukee, Wisconsin, focused on patients treated for non–small cell lung cancer (NSCLC) from January 1, 2017, to December 31, 2018. According to the abstract, Aurora’s clinicians were already familiar with clinical pathways, having transitioned to Via Oncology’s pathways in 2014. Aurora physicians reported rapid uptake of pathways; despite having 42 medical oncologists across 19 sites working with a common electronic health record (EHR), the authors reported that within 3 months of the transition, 85% of the patients were being treated on pathway.

Via Oncology pathways are now ClinicalPath, owned by Elsevier, and the oncology support program has received the “Best Computerized Decision Support Solution” in the 2019 MedTech Breakthrough Awards, as well as the 2020 MedTech Breakthrough Award.  

The Aurora physicians wanted to examine (1) the difference in the cost of care on pathway and off pathway, and (2) whether patients on pathway had lower rates of emergency department (ED) use and unplanned admissions, in accordance with CMS regulations.

Authors queried the pathway database to learn which patients within the study period had been treated on pathway and which were off pathway. Patients were further grouped into early diagnosis, advanced/curative, and advanced/non-curative. Total charges were assessed, as well as ED visits or hospital admission within 30 days of chemotherapy treatment, outside CMS regulations. The analysis compared treatment costs and ED/hospitalizations between the on- and off-pathway groups.

Over a 2-year period, 407 (81.4%) patients with NSCLC were treated on pathway, including patients in clinical trials, while 93 (18.6%) patients were treated off pathway. All patients had an Eastern Cooperative Oncology Group Performance Status of 0-2. The mean cost for patients in the pathway group was $104,436, compared with $183,717 for those off pathway (P = .01).

“Since implementing pathways, clinical trial entry rose from 27 to 66 patients per year,” the authors wrote. A smaller share of patients on pathway, 25.8%, compared with those off pathway, 29%, were among those using the ED or admitted to the hospital outside CMS regulations.

“Standardized usage of evidence-based pathways can be used successfully across a large number of providers over wide geography,” concluded the authors, led by James L. Weese, MD, system vice president for Aurora Cancer Care. “Adherence to pathways results in significant cost savings for each patient and significant rise in clinical trial entry.”

Reference

Weese JL, Shamah CJ, Sanchez FA, et al. Use of treatment pathways reduce cost and increase entry into clinical trials in patients (pts) with non-small cell lung cancer (NSCLC). J Clin Oncol. 2020;38(15 Suppl). doi:10.1200/JCO.2020.38.15_suppl.e21000

Source: AJMC By: Mary Caffrey

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