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ASCO Quality Care 2017: Cost and Survival Analysis Before and After Implementation of Clinical Pathways for Patients With Stage IV NSCLC

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Key Points

  • The total ambulatory cost of care decreased by more than $15,000 after the implementation of the pathways ($67,050 before pathways vs $52,037 after pathways).
  • Median overall survival times remained similar (10.7 months before pathways vs 11.2 months after pathways).
  • Chemotherapy, biologics, and other antineoplastic drugs represented the single largest contributor to savings.

In a study reported at the 2017 Quality Care Symposium by Zheng et al (Abstract 3) and published in the Journal of Oncology Practice by Jackman et al, researchers explored the use of clinical pathways to support clinical decision-making and manage resources for patients with late-stage non–small cell lung cancer (NSCLC).

Clinical Pathways

Clinical pathways are detailed, evidence-based treatment protocols that outline care for patients with specific disease types and stages. When properly designed and implemented, pathways can serve as an important tool to improve quality of care and manage resource utilization.

In this study, researchers at Dana-Farber Cancer Institute (DFCI) created customized lung cancer pathways and partnered with a commercial vendor to provide a web-based platform for real-time decision support and post-treatment data aggregation. The DCFI rolled out its pathways for NSCLC in January 2014. At the end of the year, the authors identified 160 patients who had been diagnosed and treated for stage IV NSCLC in 2012 prior to implementation of the pathways and 210 patients who had been diagnosed after pathways were rolled out in 2014. The ambulatory costs of care were calculated for 1 year from the time of diagnosis. 

Study Findings

The analysis revealed that the total ambulatory cost of care decreased by more than $15,000 after the implementation of the pathways ($67,050 before pathways vs $52,037 after pathways). There was no compromise in clinical outcome, with median overall survival times remaining similar (10.7 months before pathways vs 11.2 months after pathways).

Chemotherapy, biologics, and other antineoplastic drugs represented the single largest contributor to savings. This was achieved in part by reducing the use of selected high-price regimens that were not associated with significant clinical benefit.

Pathways can provide comparative outcomes, value, and standardization, all of which will be crucial and helpful for shared saving and other payment models.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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