Physicians have a lot of treatment options when treating patients diagnosed with non-small cell lung cancer (NSCLC), especially with the emergence of targeted treatments, vascular endothelial growth factor inhibitors, and the recent checkpoint inhibitors. However, these innovative treatments are expensive; moreover, not every patient will have favorable outcomes to a given treatment. Therefore, to optimize care delivery, the Dana-Farber Cancer Institute (DFCI) developed care algorithms for optimal patient management by implementing clinical pathways.
The DFCI lung cancer pathways, created in 2013, were implemented in January 2014. Results of an analysis conducted in patients with advanced stage 4 NSCLC have now been published in the Journal of Oncology Practice
. Patients were divided into 2 groups:
Prepathway group, which included patients who were diagnosed in calendar year 2012, assuring at least 12 months of follow-up prior to the pathways implementation date (n = 160).
Postpathway group included patients diagnosed in calendar year 2014, after the rollout of the NSCLC pathway (n = 210).
The study assessed demographics, clinical characteristics, treatments, charges, and utilization for each patient, in addition to their mutation status (EGFR
). The prepathway group had more women that the postpathway group. The total cost incurred for a year after diagnosis for each patient was calculated. Costs considered in the analysis were restricted to treatment received at DFCI.
The results showed that pathways resulted in $15,013 in the total cost of care per patient—the average cost per patient before pathways was $67,050 and the cost per patient being treated on a clinical pathway was $52,037. A majority of the savings were on anticancer agents.
Patient outcomes were not compromised on pathways—the median overall survival was 10.7 months in the prepathway group and 11.2 months in the postpathway group (P
These data hold significance in the context of value-based care—clinical pathways are a good example of an alternative payment model that can help control healthcare costs. The authors write that the “implementation of clinical pathways may provide a means to coalesce and disseminate institutional expertise and track and learn from care decisions.”
The data were simultaneously presented at the ongoing American Society of Clinical Oncology’s Quality Care Symposium.
Jackman DM, Zhang Y, Dalby C, et al. Cost and survival analysis before and after implementation of Dana-Farber clinical pathways for patients with stage IV non–small-cell lung cancer [published online March 4, 2017]. J Onc Pract
. doi: 10.1200/JOP.2017.021741.