Cancer care pathways cut costs by 15%

Oncology pathways programs, which provide guidelines to encourage cost-effective treatments and eliminate unnecessary interventions, can cut costs and reduce the rate of hospital admissions across a regional payer network, according to a study published online June 18 in the American Journal of Managed Care.

Researchers focused on a pathways program established by Cardinal Health, a Dublin, Ohio-based company that assists providers in improving care delivery. The program began in August 2008, when Cardinal Health partnered with a large nonprofit healthcare insurer in the Mid-Atlantic region, explained authors Bruce A. Feinberg, DO, of Cardinal Health Specialty Solutions, and colleagues. Participation was voluntary, though providers were incentivized to join.

Cardinal Health reported the program resulted in $8 million in savings from decreases in drug and nondrug expenses, but the current study involved a third-party actuarial firm to retrospectively validate the observed savings, explained Feinberg and colleagues.

The analysis included a total of 2,424 breast, colon and lung cancer patients—all the cancers covered by program pathways—who initiated chemotherapy between April 1, 2007, and April 5, 2010, in the Mid-Atlantic or New England regions. A control group of 1,400 non-pathways patients was included for comparison.

Results showed the clinical pathways program yielded a savings of 15 percent compared with non-pathways treatment, and also resulted in a 7 percent reduction in the probability of hospital admission, reported the authors.

“These savings estimates are net of participating provider incentives, which included significantly enhanced reimbursement on generic and branded drugs,” wrote Feinberg and colleagues.

The analysis also looked at variability in drug combinations and found that while both groups experienced reductions in variability over the study period, the pathways groups experienced a greater reduction in variability.

“Reducing treatment variability and encouraging proper supportive care fosters an environment in which cancer costs are lowered and lessens the likelihood of acute care interventions,” wrote the authors. “The benefits of greater familiarity with regimens, the reduction in complex chemotherapy in late-line treatment, and the avoidance of chemotherapy when evidence does not support it are demonstrated in the reduced probability of an inpatient admission.”