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A New Beginning and a Look at the Real World
In this issue, I am pleased to introduce you to a new column, Transformative Employer Trends, managed by F. Randy Vogenberg, PhD (page E1). Dr Vogenberg has over 40 years’ experience in the health care space, and he is currently a principal at the Institute for Integrated Healthcare (IIH) and the Employer Provider Interface Council (EPIC). He is a national thought leader and expert on health care delivery and economics, and employer-focused health care business relationships driving innovative solutions. The focus of this column will be the employer perspective related to various aspects of utilizing or developing pathways of care.
As we transition into value-based care, the need for real-world evidence increases as performance metrics are developed and measured. In our first feature article, Barber et al used a large payer claims database to conduct a retrospective, observational, real-world cohort study looking at adult patients with advanced ovarian cancer (page 9). The premise of the study was that while most patients with advanced ovarian cancer will initially respond to platinum-based chemotherapy, the majority will ultimately experience recurrence. Clinical trials have shown that maintenance therapy with either a PARP inhibitor or bevacizumab prolongs progression-free survival (PFS) in patients with recurrent ovarian cancer. Despite the medical evidence demonstrating benefit in improving PFS, real-world use data for these relatively new maintenance agents are lacking. This analysis examines current real-world practice patterns for patients receiving maintenance therapy for recurrent ovarian cancer.
Our second feature article continues our look at real-world evidence, evaluating the impact of a site-of-care home-redirection program for pegfilgrastim on effectiveness and timing of administration in preventing complications from chemotherapy-induced neutropenia (page 26). The FDA, ASCO, and NCCN recommend that pegfilgrastim be given to patients at least 24 hours after the last dose of myelosuppressive chemotherapy and 14 days before the first dose of chemotherapy in the next cycle. Redirection from a facility outpatient setting to a lower-cost site of service can significantly reduce overall cost, and redirecting the site of care to patients’ homes is logistically more convenient for the patients. The focus of the analysis was to determine whether redirecting medication administration from high-cost settings to quality, cost-effective settings when clinically appropriate might reduce the burden of rising health care costs and increase access and affordability for patients, while achieving at least similar outcomes.
We finish our real-world-evidence theme with a retrospective study that aimed to compare the availability of NCCN Preferred recommendations to custom preferred pathway platforms, and to assess provider concordance with the preferred suggestions (page 22). The authors note that previous studies reported that NCCN Preferred regimens were able to support 57% of clinical scenarios encountered in a real-world setting, leaving 43% of clinical scenarios unsupported, representing an opportunity for custom preferred pathways to provide oncologists with clearer guidance in this gap. The analysis was limited to breast, non–small cell lung, and colon cancers over 11 months, at 12 US-based sites of care by 522 clinicians in hospital and community-based cancer clinics.
As always, let us know any comments, questions, or suggestions you may have. And if you’d like to submit your data for publication, please visit jcponline.com.
