Guidelines can help address issues of cost and variation, especially in complex diseases, said Derek Raghavan, MD, PhD, FACP, FRACP, president, Carolinas HealthCare System's Levine Cancer Institute.
Guidelines can help address issues of cost and variation, especially in complex diseases, said Derek Raghavan, MD, PhD, FACP, FRACP, president, Carolinas HealthCare System's Levine Cancer Institute.
Transcript
What is the importance of implementing evidence-based guidelines for complex diseases, such as hematological malignancies?
One of the big problems in managing hematological malignancies is the rapidly burgeoning costs. The costs are from the new diagnostic tests that are tremendously expensive, the new targeted therapies that are even more expensive, and the fact that diagnostic companies and pharmaceutical companies are increasingly looking to make profits and going to the bottom line. And there’s a tension between that and the payers, who are increasingly looking to reduce expenditure.
One of the ways of getting around this is to structure guidelines that will take into account the best evidence base of what we do, if, for example, there are 2 agents that are equally active against a particular malignancy, then obviously physicians and patients will want to use the one that is less toxic. If these agents are equiactive, in other words have the same success rate and the same level of toxicity, then we need to be moving to the agents that are less expensive. And pharmaceutics committees are increasingly looking at that algorithm.
In the design of clinical guidelines and clinical pathways, what we have to do is overcome unnecessary variation. At the Levine Cancer Institute, where I work, we’ve actually created a mechanism where we’ve developed a series of electronically accessible pathways. They can be modified electronically, they’re created by a series of tumor-specific teams based on level 1 evidence. And, so, for every type of disease, we have a structured approach of preferred treatments, acceptable treatments, and treatments that we will not use.
Now, the trick is trying to make sure that our physicians use those treatments. There are a number of ways of incentivizing physicians. One is just simply making them do the right thing. If they’re reluctant to do that, then you can actually put financial penalties in place. As a rule, physicians are competitive and want to get the best results. So, I would anticipate over the ensuing years, with increasing pressures of cost, increasing stringency of oversight, physicians will increasingly adopt guidelines. And the reality is, if that doesn’t happen, the payers will ensure that it goes in that direction.
A Focus on Women: AUA Best Posters Highlight Female Athletes, Prenatal Care, and Women in Urology
May 9th 2024Three posters from the American Urological Association (AUA) 2024 Annual Meeting focused on urinary incontinence in female athletes, prenatal care for fetuses with spina bifida in California, and the experiences of women residents at the Brady Urological Institute.
Read More
The Importance of Examining and Preventing Atrial Fibrillation
August 29th 2023At this year’s American Society for Preventive Cardiology Congress on CVD Prevention, Emelia J. Benjamin, MD, ScM, delivered the Honorary Fellow Award Lecture, “The Imperative to Focus on the Prevention of Atrial Fibrillation,” as the recipient of this year’s Honorary Fellow of the American Society for Preventive Cardiology award.
Listen
Budesonide-Based Triple Therapy Shows Best Benefit Over Dual Therapy for COPD
May 8th 2024The triple therapy of budesonide, glycopyrrolate, and formoterol fumarate showed the greatest incremental net benefit among a series of triple therapy medications that were evaluated against dual therapy for chronic obstructive pulmonary disease (COPD), according to an analysis presented at ISPOR.
Read More
Promoting Equity in Public Health: Policy, Investment, and Community Engagement Solutions
June 28th 2022On this episode of Managed Care Cast, we speak with Georges C. Benjamin, MD, executive director of the American Public Health Association, on the core takeaways of his keynote session at AHIP 2022 on public health policy and other solutions to promote equitable health and well-being.
Listen
AUA Session Highlights the General Urologist’s Role in Gender-Affirming Care
May 7th 2024During her session, Polina Reyblat, MD, Kaiser Permanente Los Angeles Medical Center, highlighted best practices urologists should incorporate to make transgender and gender-diverse patients comfortable during physical exams and avoid retraumatization.
Read More