Defining Value for the Treatment of Brain Metastases in Metastatic HER2-Positive Breast Cancer - Episode 16
Bhavesh Shah, RPh, BCOP, provides a payer perspective on the impact of COVID-19 on site of care for patients with metastatic breast cancer and the role of value-based contracting for the future.
Bhavesh Shah, RPh, BCOP: One of the questions I always get is about whether there are treatments that increase the risk of mortality from COVID-19 [coronavirus disease 2019] for patients with breast cancer. We obviously have a lot of registries that are ongoing and looking at these data. Recently at ASCO [American Society of Clinical Oncology Annual Meeting] and AACR [American Association for Cancer Research Annual Meeting], they released a lot of the data from many of the registries. And we noticed that in breast cancer, there was no increase in risk of dying because you had COVID-19 and were receiving specific chemotherapies. That’s great, but we should continue to monitor that because we still have surges, and it’s important because these are registries: retrospective analysis. Treatment paradigms change for COVID-19 every month. New treatments are approved. We should definitely be vigilant about continuing to participate, but at least we have some preliminary evidence that shows that there’s not an increased risk of mortality for patients who have COVID-19 and have breast cancer for which they are receiving anticancer therapies or monoclonal antibodies such as trastuzumab or pertuzumab.
The other question I always get is about whether there are site-of-care shifts that are affecting patients. Are patients not coming to the clinic because they’re scared? We’ve been fortunate to have all our patients coming in for treatment in the clinic. We never saw seen a decrease in our capacity because of COVID-19. Are we doing things differently? We are not, but I know that there are institutions that are using more subcutaneous therapy where patients can self-administer pertuzumab and trastuzumab, for example, at home. We see a lot of patients who require other drugs that are IV [intravenous] administered, so there are times that it doesn’t work for everybody. That is an option that patients can self-administer at home.
We’ve been pretty vigilant about making sure our patients understand that the risk of malignancy is much more than the risk for COVID-19, so we definitely want to be in front of that and make sure they understand that as we’re seeing more surges. Some of the payers have also released new coverage guidelines, wherein drugs like immunotherapy are being approved for home administered or shifting those patients to get it at home. There have been changes from the payers. We’ve seen an increase in telemedicine, but oncology is unique because we need to provide the care that we need for our patients. We’ve seen many of our patients in person and have not had too many site-of-care shifts for breast cancer patients.
As we see more innovative therapies coming to market, we especially see this antibody-drug conjugate that has significant activity in third- and fourth-line treatment for metastatic HER2 [human epidermal growth factor receptor 2]–positive disease. Overall survival hasn’t been reached yet. As we see more of these innovations coming out, that may mean that patients will be living longer, but it’s also going to increase the cost to payers. Manufacturers are focusing on how we can help these payers offset the innovation with the cost that is going to be incurred on top of that, so what I’m talking about is outcome-based contracting. Value-based contracting is about sharing the risk on both sides: manufacturer and payer. We don’t have a lot of these restrictive criteria as an access barrier to these medications if we’re able to come to an agreement with these types of models, which are more innovative and futuristic for the care of oncology patients.