J Russel Hoverman, MD, PhD, Texas Oncology, next spoke about the performance of clinical pathways in practice. Texas Oncology has used clinical pathways for the last 10 years. In collaboration with Aetna and with US Oncology, an institutionalized decision-making process to narrow treatment choices was implemented for non-small cell lung cancer (NSCLC) and was disseminated throughout the US Oncology network. A committee reviewed off-pathway treatment decisions. In addition to treatment decisions, the pathway also included supportive services to prevent hospitalizations during chemotherapy, including patient support and advance care planning.
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The findings of the project were that drug costs far outweigh the costs of hospitalization. Dr Hoverman said that there is a more than 100% difference in the cost of oncology care from one patient to the next, and these differences are not accompanied by differences in survival. Put simply, the more chemotherapy lines used, and the more cycles of treatment, the higher costs are.
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Inpatient savings was not achieved for the oldest patients (≥80 years old) with the clinical pathways, suggesting that a different algorithm might be need to determine the treatments with the highest value for this patient population.
