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CVS Health research shows $7,084 cost disadvantage to care that is not "concordant" with National Comprehensive Care Network guidelines.
Following treatment guideline is supposed to lead to better outcomes. Data that CVS Health is presenting at the annual meeting of the American Society of Clinical Oncology (ASCO) in June suggests that it may also reduce the costs, perhaps especially when it comes to cancer care.\
A CVS Health research team led by Heeseon Yeon, Pharm.D., found that the total cost of care for nonsmall cell lung cancer patients (NSCLC) whose care was “concordant” with guidelines issued by the National Comprehensive Cancer Network (NCCN) was $7,084 less expensive than care for patients whose care didn’t follow the guidelines ($19,321 versus $26,405). That works out to be a 27% difference
For the purposes of this study, total cost included the first treatment and the subsequent 30 days
Roger Brito, divisional head, enterprise oncology, for the company and one of researchers, said they expect to broaden the scope of their research to include other cancers, but they started with NSCLC, which is the most common type of lung cancer, because of the relatively large number of medications used to treat it that are tailored to particular mutations. “Given the specificity of these treatments,” Brito wrote in an email to MHE, “when therapy regimens not aligned to NCCN guidelines are prescribed, it leads to higher costs through wasted spend on treatments that are not effective for the patient and can also lead to worse outcomes and higher costs.”
The CVS Health researchers identified 2,690 members of a Medicare Advantage plan who were NSCLC patients during the first half of the 2020. They analyzed pharmacy and medical claims to identify 2,166 patients (81%) who were “NCCN concordant” and 524 (19%) who were not. The claims also show the difference in costs.
CVS Health researchers mention the company’s proprietary technology, called Novologix, in the ASCO abstract as aiding the selection of an NCCN concordant regimen. The technology incorporates NCCN guidelines, which are updated often, in real time “ensuring prescriber have access to the most current clinical information,” wrote Brito to MHE. A company analysis — not included in the ASCO abstract — has shown the system improved treatment concordance with NCCN guidelines from about 60% to 81%, Brito told MHE.
The abstract says that from April through December of last year, 279 prior authorization were submitted via Novologix and 83% were approved automatically. The cases that weren’t resulted in peer-to-peer consultations that led to NCCN concordance, the abstract says.