As a society, we have made great strides in improving cancer care and outcomes in recent years. There are now more treatment options across more tumor types than ever before. There are targeted therapies designed for specific genetic mutations, which carry fewer side effects than traditional chemotherapy and lead to higher rates of remission and better progression-free survival.
The National Comprehensive Cancer Network (NCCN) has developed an extensive set of tools to help those navigating the complex cancer landscape to select the most optimal treatment options in terms of outcomes for the patient. Over the last 25 years, the organization has created and maintained the NCCN Clinical Practice Guidelines in Oncology, which “document evidence-based, consensus-driven management to ensure that all patients receive preventive, diagnostic treatment and supportive services that are most likely to lead to optimal outcomes.”
The NCCN Guidelines are viewed as the standard of care and function as a compendium, and they’re the most comprehensive, frequently updated guidelines in the United States. Plus, NCCN Guidelines are very broad and include information on everything from diagnostic tests to treatment, supportive and follow-up care, and survivorship.
However, another tool has emerged to help oncologists navigate the complex treatment landscape. Clinical pathways are often based on the NCCN guidelines, but they’re narrower in scope and delineate specific tumor types, patient types and stages of cancer. Similar to the NCCN Guidelines, they help oncologists select the treatment with the best outcome for the patient in terms of efficacy and toxicity. But unlike the NCCN Guidelines, they evaluate cost as a primary factor in the treatment selection process and prioritize treatments that offer the lowest cost to the patient, payer and health system. This is a key differentiator as the cost of cancer drugs has increased steeply over the last few decades: Patients and insurers paid $54,100 for a year of life in 1995 compared with $207,000 in 2013.
Over the last seven or eight years, oncologists have been increasingly turning to these clinical pathways. In fact, roughly 62% of U.S. oncologists are currently exposed to a third-party pathway—a pathway developed either by a payer or a group of oncologists—according to MMIT Pulse Analytics data.
Given the rising costs of oncology treatments and the myriad of available and constantly expanding treatment options, we expect that the utilization of pathways will continue to increase. Plus, of the oncologists who are looking to clinical pathways, adherence is high: MMIT Pulse Analytics data shows that up to 80% adhere to treatment pathways. And while oncologists have the capability to prescribe something off-pathway, many pathways have incentives and penalties in place to encourage adherence, and others require an off-pathway request to go through a committee approval process, which introduces delays to the treatment timeline. Therefore, manufacturers of life-saving oncology treatments need to pay special attention to this trend; optimal placement of their brand on a clinical pathway will help ensure that patients have access to their therapies.
Given this trend and its likelihood in determining access to therapy, it’s clear that manufacturers need to start developing a well-thought-out approach to third-party pathways and build it into their commercial strategy sooner rather than later.
To see how MMIT can help you gain insight into payer- and pathway-driven barriers to access, learn more about MMIT’s PULSE Analytics solution.