Large-Scale Oncology Pathways Program Reduces Drug and Hospitalization Costs

October 2013, Vol 4, No 8 - In the Literature


The cost of cancer care continues to rise, and especially the cost of cancer drugs. Since their introduction in the 1990s, clinical pathways have demonstrated an improvement in the quality of care, while lowering costs in numerous clinical settings. Data, however, are limited regarding the role of clinical pathways in cancer care. CareFirst BlueCross BlueShield in partnership with P4 Pathways implemented a multistate oncology pathways program in 2008. A new study evaluated the effectiveness of the program for treatment compliance, the impact of compliance on outcomes, and its ability to curb expected increases in drug and hospitalization costs (Kreys ED, et al. J Oncol Pract. 2013;9:e241-e247).

In this retrospective, single-group, pretest–posttest, researchers looked at data representing 1 year before and 2 years after the program’s initiation from a CareFirst claims database. The study included participating sites with ≥1 claims for breast, lung, or colorectal cancer treatment from each of the 3 years of the study. Compliance was defined as the site attainment of prespecified annual thresholds for the use of chemotherapy and supportive care.

Savings were determined by comparing per-patient charges in drug and hospital costs through year 2 of the pathways program, with the projected annual expenditure increases of 12% and 7%, respectively. Overall, 46 sites representing 193 physicians, 4713 patients, and 78,821 claims met the study inclusion criteria.

The results show that 83% of the sites met the unadjusted compliance rate of 65% chemotherapy benchmark after 1 year of the pathways program. For year 2, when chemotherapy compliance criteria became more stringent with the 80% benchmark, only 54% of the sites could be considered compliant; supportive care compliance was 74% for both years.

The total drug costs for the 3 years were $30.5 million for the 1 year prepathways, $33.1 million for year 1 on pathways, and $27.0 million for year 2 on pathways. Chemotherapy was responsible for 86% of the total drug costs.

Actual overall drug costs were reduced by $35 million from 1 year prepathways to year 2 on pathways. Per-patient drug costs increased only slightly, from $16,494 in year 1 prepathways to $16,906 in year 2 on pathways (95% confidence interval [CI], −1076.36 to 1900.50; P = .587).

In addition, per-patient costs for hospitalizations significantly decreased by 57% in the 3 years, from $2502 to $1064 (95% CI, −2419.16 to −455.73; P = .004). A 1.5% decrease in per-patient chemotherapy costs and a significant 30% increase in supportive care costs resulted in a small 2.5% increase in overall per-patient drug costs. Because supportive care comprised a small portion of total drug expenditures, changes in supportive care costs had a relatively small overall impact.

Of note, in sharp contrast to the projected cost increases in cancer care nationwide, the implementation of this large-scale pathways program resulted in $10.3 million in savings by participant sites ($7 million from drugs and $3.3 million from hospitalizations), or by $30.9 million when extrapolated to the entire health plan.

These findings demonstrate that an oncology clinical pathway program can be implemented on a broad, multistate scale, and can lead to considerable overall cost-savings in drug and hospitalizations at the very least.