Time to Rethink the Role of Clinical Pathways in the Era of Precision Medicine: A Lung Cancer Case Study

Abstract

Clinical pathways are intended to promote consistent evidence-based care in an increasingly dynamic treatment landscape. This implies a critical role for pathways to improve quality treatment selection as we advance into an era of precision medicine. 1 In addition to improving quality, studies in the past focusing on the treatment of non-small-cell lung cancer (NSCLC) have suggested that treatment pathways may also be a lever to reduce cancer spending by driving appropriate utilization of high-value treatments. 2,3 As such, there is an implicit belief that inappropriate drug utilization is a key contributor to rising drug costs, leading to the inclusion of drug spend in many oncology value-based care models such as the Center for Medicare and Medicaid Innovation's Oncology Care Model. 4

Affirming the Value of Clinical Chemotherapy Pathways Programs

“…Notably, there are other regimens with National Comprehensive Cancer Network category 1 status not mentioned, such as nivolumab/ ipilimumab with or without additional drugs in combination. There are a number of other considerations used by pathways programs that may differentiate among regimens: (1) toxicity; (2) potential extra expense because of vial size and opportunity to dose round, both important in reducing waste; (3) the combination of drugs and duration and therefore expense of the maintenance regimen; and (4) downstream costs affecting the total cost of care. One aspect of the current expense of drugs is that small percentages of cost reduction can lead to substantial savings.…”

“…Schleicher et al 1 have investigated about “Time to rethink the role of clinical pathways in the era of precision medicine: a lung cancer case study.” In this article, the authors argue that since the two of the top choices for non–small-cell lung cancer chemotherapy treatment are very expensive with little difference in costs, perhaps pathways programs as an attempt to reduce drug costs are outdated and unnecessary. This is a specious argument on a number of levels.…”