Published: March 13, 2010
Experts Highlight Impact of Evidence-Based Practice Guidelines on Cancer Care and Cost
HOLLYWOOD, Fla. - (BUSINESS WIRE) - The escalating costs of cancer care combined with variations in
concordance with evidence-based practice guidelines is putting the
United States on a collision course for an impending collapse of its
current health care system according to roundtable panelists at the NCCN
15th Annual Conference. Clifford Goodman, PhD, of The Lewin
Group, led an engaging roundtable debating the utilization of the NCCN
Clinical Practice Guidelines in Oncology (NCCN Guidelines )
and the impact of escalating health care costs.
Dr. Goodman began the session by questioning the panelists on how the
NCCN Guidelines were being used and their appropriate role.
Aetna Inc. spends upwards of $1.5 billion a year on cancer care and use
the NCCN Guidelines as part of its care decisions as well as
reimbursement methodology, noted James D. Cross, MD, of Aetna Inc. "It's
extraordinarily rare that treatment is denied by Aetna in a
life-threatening illness," he noted.
Lee N. Newcomer, MD, of UnitedHealthcare stated that United spends $3
billion annually on cancer care and also utilizes the NCCN Guidelines
and NCCN Drugs & Biologics Compendium (NCCN Compendium )
to make coverage decisions.
"We recently launched a new program that combines clinical and claims
data to gauge physicians' rate of compliance with the NCCN Guidelines,"
Dr. Newcomer added. "Reports are sent to the physicians that include
their compliance rates as well as information about their patients
including if they are filling their prescriptions."
Dr. Newcomer stated that the data should be used as a quality
improvement method and not to judge physicians.
In addition to physicians, patients need to be aware of evidence-based
guidelines and their role in coverage determinations stated Nancy
Davenport-Ennis, of the National Patient Advocate Foundation.
"In the last 14 years, our organization has closed more than 500,000
cases and the NCCN Guidelines are often used by our case managers to
fight and win appeals," said Davenport-Ennis. "Patients should be
encouraged to enter into a dialogue with their physicians about the cost
implications of treatment and how it relates to the type of insurance
they have. Their main concern is what is the best intervention for me
and how do I know if it's the best. The NCCN Guidelines provide a third
party authorization of the treatment their physician is recommending."
Following evidence-based practice guidelines can also have an effect on
the overall cost of treatment as Dr. Cross described a recent article
that Aetna published finding that overall care was 35 percent less
expensive if treatment guidelines were followed.
"This further demonstrates the reach that evidence-based guidelines have
and can be looked upon as the commonality that brings patients,
physicians, and insurers together," said Dr. Cross.
Physicians adherence to guidelines is still an evolutionary process
noted Al B. Benson III, MD, of the Robert H. Lurie Comprehensive Cancer
Center of Northwestern University, but he sees them permeating across
the medical enterprise.
"I've seen notes embedded into reports or on letterhead from other
physicians stating that they follow the NCCN Guidelines," said Dr.
Benson. "I believe we'll continue to see instances like this especially
as we instill the importance of the NCCN Guidelines into residency and
fellowship programs."
The NCCN Guidelines are certainly being used across various applications
Dr. Goodman noted, but questioned the panelists on what they do when
they've exhausted all options in the guideline and how these decisions
impact cost.
Dr. Benson stated that referral to a clinical trial is usually the
recommendation, but the challenge lies in finding an appropriate trial
that is enrolling for each patient.
Although the end of a cancer patient's life is often thought to be the
most expensive, when desperation may set in and patients may be willing
to try anything with potential benefit, Dr. Newcomer noted a report that
debunked the concept.
"We recently analyzed data and found that the costs actually remained
constant from month to month, with the exception being in leukemia and
lymphoma cases. The highest expenditures were hospitalizations related
to complications from the disease," said Dr. Newcomer.
However, he cautioned against physicians using "off the shelf" therapies
after options within the NCCN Guidelines are exhausted stating that
unknown toxicities could actually harm the patient.
"The end of life is the time when research protocols should come into
play," stated Dr. Cross. "The challenge is that physicians and patients
may be unwilling to end their relationship with each other, if the trial
is elsewhere, or that they may not have coverage for the costs
associated with the clinical trial."
The issue of reimbursement continued to be a focal point as Douglas
Lind, MD, of GBP Capital, admitted that reimbursement has entered into
the innovation process. "Our central question used to relate to how a
potential therapy fared in a clinical trial, and now the question is
'will it be reimbursed?' It's not intended to suppress innovation, but
rather direct it," he noted.
Other panelists expressed concern that reimbursement would stifle
innovation in a field where it's relied on heavily for advancements
although Dr. Cross stated, "Economic efficiencies has to be part of the
equation as we tackle the question of what we can afford to provide."
The United States health care system is headed for an economic collapse
given the insurmountable costs of care that are not being addressed,
expressed Dr. Newcomer.
He also stated that individuals are being forced into an increasingly
worsening trade-off in purchasing health care coverage. He described
rising costs of coverage over a 30-year span: in 1970, a minimum wage
worker needed to spend 15 percent of his income to purchase a healthcare
plan. In 2005, that same worker would need to spend 101 percent of his
income for health care insurance.
Jayson Slotnik, of Foley Hoag LLP, echoed Dr. Newcomer's sentiments
stating that even if nothing in the current health care reform proposal
is passed, that the discussion alone will lead to an impending change of
the marketplace.
To conclude, Dr. Goodman asked the panel members how oncology care can
control costs. Although the answers varied, all panelists believed that
access to appropriate care was critical.
Joseph S. Bailes, MD, of the American Society of Clinical Oncology,
summed up the discussion by stating, "The most expensive individual to
treat is one that is not treated correctly."
About the National Comprehensive Cancer Network
The National Comprehensive Cancer Network (NCCN®),
a not-for-profit alliance of 21 of the world's leading cancer centers,
is dedicated to improving the quality and effectiveness of care provided
to patients with cancer. Through the leadership and expertise of
clinical professionals at NCCN Member Institutions, NCCN develops
resources that present valuable information to the numerous stakeholders
in the health care delivery system. As the arbiter of high-quality
cancer care, NCCN promotes the importance of continuous quality
improvement and recognizes the significance of creating clinical
practice guidelines appropriate for use by patients, clinicians, and
other health care decision-makers. The primary goal of all NCCN
initiatives is to improve the quality, effectiveness, and efficiency of
oncology practice so patients can live better lives.
The NCCN Member Institutions are: City of Hope Comprehensive Cancer
Center, Los Angeles, CA; Dana-Farber/Brigham and Women's Cancer Center |
Massachusetts General Hospital Cancer Center, Boston, MA; Duke
Comprehensive Cancer Center, Durham, NC; Fox Chase Cancer Center,
Philadelphia, PA; Huntsman Cancer Institute at the University of Utah,
Salt Lake City, UT; Fred Hutchinson Cancer Research Center/Seattle
Cancer Care Alliance, Seattle, WA; Arthur G. James Cancer Hospital &
Richard J. Solove Research Institute at The Ohio State University,
Columbus, OH; The Sidney Kimmel Comprehensive Cancer Center at Johns
Hopkins, Baltimore, MD; Robert H. Lurie Comprehensive Cancer Center of
Northwestern University, Chicago, IL; Memorial Sloan-Kettering Cancer
Center, New York, NY; H. Lee Moffitt Cancer Center & Research Institute,
Tampa, FL; Roswell Park Cancer Institute, Buffalo, NY; Siteman Cancer
Center at Barnes-Jewish Hospital and Washington University School of
Medicine, St. Louis, MO; St. Jude Children's Research
Hospital/University of Tennessee Cancer Institute, Memphis, TN; Stanford
Comprehensive Cancer Center, Stanford, CA; University of Alabama at
Birmingham Comprehensive Cancer Center, Birmingham, AL; UCSF Helen
Diller Family Comprehensive Cancer Center, San Francisco, CA; University
of Michigan Comprehensive Cancer Center, Ann Arbor, MI; UNMC Eppley
Cancer Center at The Nebraska Medical Center, Omaha, NE; The University
of Texas M. D. Anderson Cancer Center, Houston, TX; and
Vanderbilt-Ingram Cancer Center, Nashville, TN.
For more information on NCCN, please visit NCCN.org.
NCCN
Megan Martin, 610-550-1621
martin@nccn.org
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