Clinical Pathways Successfully Drive Physicians to Lower-Cost Regimens in Colorectal Cancer

Clinical pathways can successfully be used to drive physicians to choose a less costly regimen when the efficacy and toxicity of different treatment regimens for metastatic colorectal cancer are comparable, according to a study in the Journal of Oncology Practice.

Researchers analyzed data from 2 cancer centers to compare use of cetuximab and panitumumab before and after the clinical pathway was changed to make the less costly regimen the primary recommendation.

“Given the comparable efficacy and similar toxicities of cetuximab and panitumumab, cost to the payer and/or the patient could be considered a deciding factor regarding which treatment to prescribe,” the authors wrote.

A clinical pathway is one way to ensure the use of a lower-cost treatment. The pathway chooses a superior therapy based first on efficacy data. If efficacy between 2 or more drugs is comparable, then the one with less toxicity is made the preferred treatment. And if both efficacy and toxicity are equal, then the lowest cost treatment is recommended.

Cost for of cetuximab was calculated using the cost of the smallest available vial size and assuming a 16-week course for an average price of $44,303. Using the same calculation for panitumumab, the average cost was determined to be $37,827. As a result, the recommended therapy in the pathway was switched to panitumumab. Physicians are always allowed to make off-pathway decisions.

The analysis of treatment decisions determined that that change in the pathway resulted in a significant change in prescribing. Before the change in the pathway, cetuximab represented 93.5% of selections compared with just 6.5% of selections for panitumumab. After the change, only 18.1% of selections were for cetuximab and 81.9% of selections were for panitumumab.

Using the postimplementation prescribing rates and the volume of patients receiving one of these 2 treatments over the course of 1 year, the researchers determined that annualized cost savings would be $711,020 as a result of the pathway change to make panitumumab the preferred treatment regimen.

“This study demonstrates that clinical pathways can act as a tool to assist oncology practices in decreasing costs and quickly responding to changing treatment paradigms by providing clinicians with consensus-driven treatment recommendations that incorporate the most up-to-date clinical trial results, toxicity considerations, and regimen cost information,” the authors concluded.