Bhuvana Sagar, MD: Clinical pathways in lung cancer have been shown to improve cost of care. At Cigna, we follow NCCN [National Comprehensive Cancer Network] Guidelines for coverage determinations for lung cancer (at this time). Ideally, we would like for the clinical guidelines to be followed in that particular stage of cancer and treatment decisions to be based on the mutation status or what line of therapy the patient is receiving.
NCCN Guidelines have been put forth for the management of lung cancer. They address the lines of therapy, the mutation status, and the patient’s performance status. Adherence to guidelines, overall, should improve quality of care, and this has been published in the past. Pathways have also been shown to decrease cost of care. At Cigna, we cover NCCN Guidelines, which have category 1, 2A, or 2B evidence, and we believe that adherence to those guidelines will improve quality of care.
The influence of site of care in the overall cost of care is an important topic that’s being discussed at this time. When patients receive care out in the community versus when they receive care in an integrated system, the cost of care is significantly different. It is possible that in certain situations, let’s say for clinical trial enrollment and so on and so forth, patients might do better when they are in an integrated delivery system. But when they can receive the same chemotherapy at a lower cost of care, that would ideally drive affordability.