For the nearly two million Americans diagnosed with cancer each year, timing is critical. This means it’s crucial to focus on making complex processes simpler, getting patients started on the most effective treatment at the right time, and supporting patients throughout their cancer care journeys.
Oncology also remains one of the highest-cost therapeutic categories. Cancer drug prices continue to rise, and recently developed agents may cost nearly $500,000 per year. Although cancer drugs are some of the most expensive on the market, they account for only 20 percent of total costs of care. Based on population growth alone, total cost of cancer care is expected to rise 34 percent by 2030. Solutions that eliminate waste and get patients on the most appropriate, targeted therapies faster are more important than ever to ensure that we are effectively managing cost while helping improve outcomes.
Fortunately, ongoing research continues to advance our understanding of how this can be achieved. This week, the American Society of Clinical Oncology (ASCO) Annual Meeting will showcase the latest insights and clinical approaches to fighting the disease, including research from CVS Health on addressing cost of care and improving access to new, innovative treatments. Included among these presentations are data that shows:
Using evidence-based guidelines ensures patients get started on the most clinically appropriate treatment faster — while lowering costs
As clinical guidelines adapt to new treatments and care regimens, pairing each patient with the right treatment can be a challenge. Any time lost to delayed diagnosis or sub-optimal treatment can lead to disease progression, higher morbidity and mortality, and higher costs.
In an abstract presented this week, researchers evaluated how automated prior authorization, integrated with regimen-level National Comprehensive Cancer Network (NCCN®) guidelines, could reduce costs while getting patients started on the right treatment for them, faster. This approach — designed to guide patients and their providers to the most effective treatment — showed a 27 percent reduction in the total cost of care. It also improved compliance with clinical guidelines from an industry average of 60 percent to 81 percent, meaning more patients are getting on the most appropriate targeted therapy regimens. While this study focused on Non-Small Cell Lung Cancer (NSCLC), findings could translate to other diagnoses, making starting on treatment more efficient and supporting lower costs of care.
This research demonstrates one benefit of CVS Health’s Transform Oncology Care program, which uses an innovative precision medicine approach to leverage NovoLogix, our proprietary technology platform to approve treatment at a regimen level with NCCN® guidelines directly integrated into the platform, and updated in real time. In close coordination with oncologists and coupled with the results of broad-panel gene sequencing, Transform Oncology Care enables clinically sound prescribing decisions, as well as ongoing care management and patient support.
Predicting potential side effects could improve care experience and reduce emergency visits
For people undergoing cancer treatment, side effects from medication can often be as challenging and disruptive as the disease itself. Using data to identify which patients are most likely to present serious side effects based on demographics, disease, and treatment type and proactively mitigating their impact can help improve condition management. For many people with cancer, unmanaged side effects can lead them to seek emergency care, raising the total cost of cancer care significantly.
According to research also being shown this week, 76 percent of oncology patients who visited an emergency room presented with oncology drug-related side effects, and 36 percent of them were admitted to the hospital. The study showed patients with certain demographic indicators, as well as those with specific cancer types, were more likely to be admitted following an emergency visit. Researchers also concluded that people who came to the emergency department with certain primary complaints — sepsis, pneumonia, medical complications, white cell disorders, metastatic cancer, and fractures — were significantly more likely to be admitted for a hospital stay.
Proactive care management provides convenient support for patients while preventing unnecessary emergency department visits. Transform Oncology Care connects members at the highest risk of side effects and costly, adverse events with specially trained nurses right from their homes, digitally or over the phone. Timely, nurse-led interventions can help manage side effects and symptoms and improve the patient experience while reducing the risk of costly emergency care.
Ongoing research to support patients, payors and providers
Additionally, CVS Health will be sharing data on cost trends in chemotherapy delivery in both hospital and outpatient settings, and a study focused on approaches to improving patient adherence to a common breast cancer treatment that often causes notable gastrointestinal side effects. Such research informs our solutions and approach to make cancer care simpler and more accessible for patients.