A study recently conducted by US Oncology and Aetna (NYSE:AET) finds that evidence-based care for patients with non-small cell lung cancer (NSCLC) results in an average cost savings of 35 percent over 12 months while demonstrating equivalent health outcomes. The study, which compared patients treated with evidence-based guidelines (also known as ‘on pathway’) to those treated with non-evidence-based guidelines (also known as ‘off pathway’), was published in the peer-reviewed Journal of Oncology Practice.
“This study also shows the benefits of physicians and insurers working together to provide data and results. We look forward to continuing to work with US Oncology to further research ways we can collaborate to improve the quality of care for Americans battling cancer.”
The evidence-based medicine pathways are treatment guidelines set by US Oncology’s network of physicians based on Level I evidence, or evidence that has been published in peer-reviewed journals demonstrating treatment methods that are proven to have the best outcomes with the least harmful side effects for the majority of patients. Aetna provided data on the average payer costs for treating NSCLC patients, providing a key point of comparison to determine cost savings.
“For several years, US Oncology network physicians have been committed to providing high-quality, cost-effective cancer care through the development and adoption of our evidence-based Level I Pathways,” says Marcus Neubauer, M.D., with Kansas City Cancer Center, an affiliate of US Oncology and principal investigator in the study, “We expected costs to be lower with Pathway adherence, but for us to completely validate Pathways as a quality care, low-cost solution we needed to show that survival was not compromised; this study proves that the use of Level I Pathways results in enhanced cancer care value while maintaining equivalent clinical outcomes.”
Currently, there is limited empirical evidence regarding the cost-effectiveness of newer treatment strategies. “To our knowledge, this is the first study to empirically measure the cost-effectiveness of evidence-based treatment guidelines for cancer therapy,” says Roy Beveridge, M.D., medical director with US Oncology and investigator on the study. “The results suggest that treating patients according to evidence-based guidelines is a cost-effective strategy for delivering care to patients with NSCLC, especially in the adjuvant and first-line settings. We also found that there were no observed differences in outcomes, suggesting that the added cost associated with treating patients off Pathways did not translate to improved outcomes. This is a great example of cancer care that can save patients, and the nation’s health care system, millions of dollars and produce equally effective results.”
“Through our collaboration with US Oncology, we were able to work together to study how to improve the quality of care people receive when they are undergoing cancer treatment, while also showing that evidence-based medicine can reduce health care costs,” said Lonny Reisman, M.D., Aetna’s Chief Medical Officer. “This study also shows the benefits of physicians and insurers working together to provide data and results. We look forward to continuing to work with US Oncology to further research ways we can collaborate to improve the quality of care for Americans battling cancer.”
US Oncology, Inc. supports the nation’s foremost cancer treatment and research network in association with more than 1,300 physicians who work in 493 communities across the United States. The company created Level I Pathways, a physician-led initiative that ensures the consistent delivery of value-driven, evidence-based treatment, to drive quality care for patients diagnosed with the most common cancers. The underlying goal of Level I Pathways is to delineate treatment options that maximize survival benefit, minimize toxicities, and provide cost-savings advantages that benefit both the patient and the payer.
Lung cancer is the 2nd most commonly diagnosed cancer in the United States, following skin cancer, and is the leading cause of cancer-related deaths. NSCLC makes up approximately 80 percent of lung cancer cases in the United States and no single regimen has emerged as the superior treatment choice for patients with advanced cases. There is limited evidence regarding the cost-effectiveness of newer treatment strategies. The economic cost of lung cancer is high, with an estimated annual cost of $9 billion.
STUDY METHODS
Patient Identification and Characterization
- From July 1, 2006 through December 31, 2007, all NSCLC patients initiating a chemotherapy regimen at eight practices within the US Oncology Network were identified.
- Of a total 1,409 NSCLC patients; 1,095 (78%) were treated ‘On-Pathway’ while 314 (22%) were treated ‘Off-Pathway.’
- Patients were classified as being treated: 1) ‘On Pathway’ if they received care according to Level I Pathways treatment recommendations over the entire study time period; 2) ‘Off Pathway’ if they were treated with any regimens not included Level I Pathways.
Cost Analysis
- We compared the twelve month cost of care for patients ‘On Pathway’ vs. ‘Off Pathway’.
- The cost data was provided by Aetna and the analysis was conducted from a payer’s perspective and considered only direct costs.
- The analysis included overall cost and cost broken into several categories, including but not limited to: total cost, outpatient visits, chemotherapy and non-chemotherapy medications, laboratory services, hospitalizations, and ancillary services/therapies.
RESULTS
- We found that overall cost of care was less for NSCLC patients treated ‘On Pathway’ compared to patients treated ‘Off Pathway’.
- Over 12 months, average cost of care for patients On Pathway was 35% less compared to patients treated ‘Off Pathway’.
- This cost difference was driven predominately by significantly lower costs for chemotherapy and other medications.
- We also found that there were no observed differences in 12 month overall survival by Pathway status, suggesting that the added cost associated with treating patients ‘Off Pathways’ (including therapy beyond 3rd line) may not translate to improved outcomes.
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