San Fransisco, CA—An economic model designed to determine the cost of instituting a clinical pathway inmetastatic colorectal cancer (mCRC) showed that the costs associated with implementing such a pathway may outweigh any potential cost-savings it may provide, at least for the near-term, according to Tanya G.K. Bentley, PhD, PHAR LLC, Beverly Hills, CA, and colleagues. They presented their study results at a poster session during the 2016 Academy of Managed Care Pharmacy annual meeting.
Clinical pathways aim to standardize clinical care, resulting in improved outcomes and lower costs. However, because of fees associated with the development and administration of clinical pathways, the net economic benefit of implementing clinical pathways is not known.
“Though pathways intend to control costs by reducing variation in treatment patterns, the net impact of pathways on cost of care is not clear given the additional costs associated with pathway initiation and administration, including reimbursement incentives to clinicians who treat patients with on-pathway regimens,” noted Dr Bentley and colleagues.
Using an economic model to evaluate pathway implementation in mCRC, the researchers compared the cost of treatment with panitumumab (Vectibix)-based regimens, which was considered on-pathway, versus cetuximab (Erbitux)-based regimens, which was off-pathway, in adult patients with KRAS wild-type mCRC. The overall costs included genetic testing, drug acquisition and administration, adverse event treatment, and pathway implementation.
The costs of pathway implementation and utilization, as well as incentive fees, included the following features:
Among a hypothetical 1-million--member plan, the team estimated that 53 patients would receive treatment for KRAS wild-type mCRC. This results in an annual cost of treatment of $3,829,730 with pathway implementation versus $3,750,774 without pathway implementation. This approximately $79,000 increase in costs associated with the clinical pathway amounts to an increase of $0.0066 per member per month, for payers.
The primary increase in cost was associated with fees related to the pathway only. The cost of pathway implementation alone added an extra $101,304 to the cost of pathway utilization; much of that increased cost came from physician incentive payments.
However, pathway implementation reduced the costs associated with drug administration and adverse events by $60,009 and $5229, respectively.
Overall, Dr Bentley and colleagues suggested that although clinical pathways may lower costs by eliminating treatment variability and drug costs, the costs associated with pathway--related incentives and administration should be taken into consideration when considering the potential cost-saving initiatives.
