Payers’ Support of Clinical Decisions Allows Providers to Choose Most Effective, Cost-Saving Therapies

Ira M. Klein, MD, MBA, FACP

November 2012, Vol 3, No 8 - VBCC Perspectives


?The cost of cancer care is staggering. Global sales of cancer drugs alone are forecast to grow at a rate of 12% to 15% annually, reaching $75 billion to $80 billion by the end of this year, according to IMS Health.1

Clinical leadership is one of the critical keys to controlling quality and costs in healthcare. Every other segment of the healthcare system also has a role to play. At Aetna, we work to influence the creation of safer, more effective, and more affordable healthcare through clinical evidence and unprecedented collaboration.

We look to medical evidence— published, peer-reviewed results that show which treatments and procedures have been scientifically proven to be effective—to create clinical policies, which form the basis of coverage policy.

Based on the current evidence, we consider ziv-aflibercept (Zaltrap) medically necessary for the treatment of patients with colorectal cancer. But being proved medically necessary for a broad condition does not mean that it is the best treatment for every patient.

We look to doctors, such as Peter B. Bach, MD, and his team, to constantly add to the body of knowledge for cancer care, especially experience that further clarifies the effectiveness of a therapy based on specific characteristics of the patient. Oncologists can learn from the collective experience, which is what evidence-based pathways are all about. We applaud Dr Bach and his team for incorporating costs into their evaluation of the best treatment op­tions. The oncology community is in the best position to help eliminate costs that do not bring additional value to patients.

For our part, we help ensure that these evidence-based care standards can be quickly shared. Aetna enables technology and real-time clinical decision support to allow doctors and patients to decide together the most effective and cost-efficient treatments. We are also developing new payment models to support evidence-based quality of care rather than quantity of care or drug costs.

A recent study by Aetna and US Oncology found that evidence-based care for patients with non–small-cell lung cancer resulted in an average cost-savings of 35% while demonstrating equivalent health outcomes.2 We know that collaborating with the on­cology community to support high-quality, evidence-based care can actually reduce costs and save patients, as well as the nation’s healthcare system, millions of dollars.

References

  1. Gavel SJ. The oncology pipeline: maturing, competitive, and growing? http://imshealth.com/deployedfiles/imshealth/Global/Americas/North%20America/ United%20States/StaticFile/Oncology_Pipeline.pdf. Accessed November 3, 2012.
  2. Neubauer MA, Hoverman JR, Kolodziei M, et al. Cost-effectiveness of evidence-based treatment guidelines for the treatment of non–small-cell lung cancer in the community setting. J Oncol Pract. 2010;6:12-18.