Segment 9 – The Use of Expensive or New Immunotherapies in Clinical Pathways

Published Online: June 30, 2014
In regard to updating pathways and guidelines, Dr Sonnad asked about the opportunity for newer, expensive immunotherapies to be included in a pre-determined pathway.

Dr Nabhan said one cannot exclude a drug just because it’s expensive. It takes time to understand the collective cost of a particular drug on a patient population, and how it impacts the healthcare community, which includes payers, provider, and patient.

“Any drug that has been approved by the regulatory authorities because it had demonstrated a benefit for patients, improved survival, improved clinical benefit, etcetera, cannot be excluded from a pathway. I think it’s critical, especially when you have an abundance of evidence,” said Dr Nabhan. “You have to balance the cost versus the benefit.”

Dr Malin agreed, saying WellPoint rewards quality care. If a new therapy improves patient outcomes on the pathway, they won’t exclude it solely based on cost. Pathways, like the rest of clinical medicine, is an iterative process. Groundbreaking therapies that could change the outcomes of a large patient population, for instance, might warrant immediate regimen integration.

Dr Malin added that as evidence accumulates, therapies could be added or removed depending on their toxicity.