On-Pathway Regimens Associated With Significant Cost Savings in Cancer Care


On-pathway regimens are associated with lower costs, and slightly higher emergency department visits and adverse event rates in cancer care.

On-Pathway Regimens Associated With Significant Cost Savings in Cancer Care

On-Pathway Regimens Associated With Significant Cost Savings in Cancer Care

Findings from a cross-institutional study suggest that, for patients with cancer, on-pathway regimens led to significant cost savings, although the rate of hospitalizations and immune-related adverse events (irAES) were similar between on-pathway and off-pathway regimens. The results were published in the Journal of Clinical Oncology.1

On average, prescribing on-pathway regimens led to a $17,589 reduction in total health care cost per patient (95% CI, –$23,790 to –$11,388; P < .001) and a $22,543 reduction in chemotherapy cost per patient (95% CI, –$27,666 to –$17,420; P < .001).

The rate of hospitalization, for any cause, was highest among on-pathway patients with melanoma (adjusted odds ratio [aOR], 1.679; 95% CI, 1.115-2.529; P = .013), yet the rate of treatment-related hospitalization was similar between the 2 groups. The rate of treatment-related hospitalization between the 2 groups was 25.2% vs 22.9%, respectively (aOR, 1.080; P = .201). The rates of irAEs were also comparable between the 2 arms and were reported at rates of 75.2% vs 74.6%, respectively (aOR, 0.961; P = .497).

“Among patients who received first-line cancer treatment for metastatic solid tumors, use of [Cancer Care Quality Program ]-endorsed on-pathway treatment regimens was associated with significant cost savings,” Ying Liu, PhD, of Elevance Health, and co-investigators, wrote in the study. “Overall, there was a significant reduction in total health care cost for patients prescribed with on-pathway regimens, driven mainly by the lower cancer drug costs for this group.”

Insurance companies in the United States have developed oncology clinical pathways to combat the rise of cancer drug costs and variation in quality of care.2 Approximately 60 health insurance plans have adopted these pathways, which comprise of a subset of evidence-based regimens selected for their efficacy, toxicity, and costs. Expert panels review the pathways quarterly and update them when necessary. The Cancer Care Quality Program (CCQP) is 1 such pathway, and was launched in July 2014 by Aim Specialty Health.3 Of note, physicians are encouraged to use this pathway; they receive incentive pay of $350 per-patient per-month for prescribing on-pathway regimens.1

Investigators sought to evaluate the toxicity outcomes and cost outcomes for patients with metastatic cancer who were prescribed on-pathway. They looked at emergency department (ED) visits, supportive care medication administration, and adverse events to assess toxicity outcomes, and medical costs, pharmacy costs, and out-of-pocket patient costs, to assess treatment expenditure.

To conduct this study, investigators looked at claims and authorization data for patients with 9 different metastatic tumor types: melanoma, breast, lung, colorectal, pancreatic, kidney, bladder, gastric, and uterine cancer. They collected data from the CCQP data and registry files between January 1, 2019, through October 31, 2021. These data were linked to the Healthcare Integrated Research Environment to gain additional information on patient characteristics, their health care plan, and the costs of their care.1

The study parameters defined a treatment-related hospitalization or ED visit as at least 1 inpatient or ED claim related to any of the following AEs: anemia, nausea, dehydration, neutropenia, pain, pneumonia, fever, sepsis, cough, fatigue, constipation, appetite loss, dysuria, flushing, or neuropathy. irAEs included complications such as endocrinopathies, hepatitis, and myocarditis.

The study included data from 8357 patients, 5453 of whom (65.3%) received on-pathway regimens. Throughout data collection, the proportion of on-pathway patients grew smaller–starting at 74.3% in 2018 and landing at 59.8% in 2021.The median patient age was similar for both cohorts (54.6% vs 59.5%; P = .056), and the on-pathway group included fewer women (54.6% vs 57.3%; P = .021).1

In the 6 months prior to the index date (IQR, 1-2), patients who were prescribed an on-pathway regimen experienced fewer distinct lines of therapy (mean, 1.30) compared with the off-pathway cohort (mean, 1.34; P = .003).

Patients who were prescribed an on-pathway regimen experienced more-all cause hospitalizations (36.4%) compared with off-pathway patients (31.8%; aOR, 1.154; P = .008). The rates of all-cause ED visits and treatment-related ED visits were also higher in this group (27.7% and 18.1%) than with their counterparts (23.3% and 15.0%). The aOR for all-cause ED visits and treatment-related ED visits were 1.161 in both arms (P = .011 vs P = .032).1

In terms of cost, the out-of-pocket costs for patients who were prescribed on-pathway regimens were $274 less than for their off-pathway counterparts (95% CI, –$506 to –$42; P = .021). There were no statistically significant differences between the 2 groups in terms of pharmacy costs and nonchemotherapy costs (P > .05).

In addition, on-pathway bladder, breast, and lung cancer treatments were associated with significant reductions in total health care spending. The cost savings associated with each of these cancer types were ($50,489, $21,734, and $16,409, respectively; P ≤ .001). Bladder, breast, colorectal, and lung cancers were linked to significant savings in cancer drug costs ($75,151, $17,388, $16,404, and $16,233, respectively; P < .001), although no significant difference was reported in the remaining cancer types.

Excluding the cancer drug costs, the total spending was similar between the 2 groups for all subtypes besides colorectal cancer—in which the on-pathways regimens were associated with $10,076 additional costs (95% CI, $585 to $19,566; P = .037).

The use of supportive care was reported to be greater among patients in the on-pathway group who had bladder cancer (aOR, 4.602; P < .00) and colorectal cancer (aOR, 4.465; P < .001). However, patients in the on-pathway group who had breast cancer (aOR, 0.668; P = .001) or lung cancer (aOR, 0.550; P < .001) received fewer supportive care drugs. The rate of any supportive care use, regardless of disease type, was 81.3% for on-pathway patients, and 79.5% for off-pathway patients (aOR, 0.913; P = .195).


  1. Liu Y, Mullangi S, Debono D, et al. Association between oncology clinical pathway utilization and toxicity and cost outcomes in patients with metastatic solid tumors. JCO Oncol Pract. Published online June 29, 2023. doi:10.1200/OP.23.00199
  2. Clinical pathways. American Society of Clinical Oncology. Accessed July 11, 2023. https://www.asco.org/news-initiatives/clinical-pathways 
  3. Cancer care quality program. Carelon. Accessed July 11, 2023. https://aimproviders.com/medoncology-anthem/
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