Cancer Care Pathway Utilization Reduces Cost in Breast Cancer

Samantha DiGrande

A recent study looked to use real-world data to support the value of pathway regimens designed to create high-quality, affordable treatment in breast cancer care. 

Oncology practices have developed or adopted evidence-based treatment guidelines as one mechanism for implementing clinical value frameworks. Despite the potential of these programs, there remains a lack of evidence to support their value. Researchers used nationally representative claims data from Anthem, combined with clinical data from its Cancer Care Quality Program, and identified patients with breast cancer for whom chemotherapy was initiated between January 2015 and October 2016.

Patients receiving a pathway regimen (identified as the on-pathway cohort) were matched to those who did not (referred to as the off-pathway cohort) using a 1:1 match. The study compared quality of care outcomes, including hospitalization, emergency department (ED) visits, a patient need for supportive drugs, and cost outcomes, between the cohorts after 6 months post treatment. 

In total, each cohort enrolled 959 patients. The age distribution in each cohort was similar; the median age was 52 years in the off-pathway cohort versus 53 years in the on-pathway cohort. The 2 cohorts had similar hospitalization and EDt visit rates, however, supportive care drugs were used significantly less often in the on-pathway cohort (72.5% in the on-pathway cohort vs 82.8% in the off-pathway cohort; odds ratio, 0.55; P ≤.0001). Importantly, the average cost of care was $16,176 lower in the on-pathway cohort (95% CI, –$24,291 to –$8061; P ≤.0001). 

“Our main finding was that treatment of patients with breast cancer with on-pathway regimens was associated with a reduction in cost without compromising quality of care as evident by comparable rates of hospitalization and ED visits and less use of supportive drugs,” said the study authors. In terms of future research, the authors noted that opportunities include evaluating provider factors associated with the selection of off-pathway regimens, surveys of patient and provider experience, and long-term measures of pathway effectiveness.

Gautam S, Sylwestrzak G, Barron J, et al. Results from a health insurer’s clinical pathway program in breast cancer [published online October 15, 2018]. J Oncol Pract. doi: 10.1200/JOP.18.00157.
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