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Summary

Avalere analysis finds that approximately 1 in 5 Medicare beneficiaries with advanced urothelial carcinoma (UC) or renal cell carcinoma (RCC) see a physician that has access to McKesson Value Pathways or Elsevier ClinicalPath vendor clinical pathways programs

Clinical pathways are decision support tools for providers that align with clinical guidelines and other standards to create a population-level treatment algorithm for a diagnosis based on efficacy, safety, and cost data. The 2 most prominent users of clinical pathways are providers, who utilize pathways to provide consistent and streamlined care for patients, and payers, who sometimes use pathways as a utilization management tool. Clinical pathways have continued to gain traction in therapeutic areas where the growing availability of treatment options and the frequent updating of evidence require continued alignment of data to choose the best treatments for patients.

In oncology, the use of clinical pathways is increasing and expanding. With additional treatment options, clinical pathways have moved beyond the most common cancer types (e.g., lung, colorectal, breast) to include less prevalent cancers, such as UC and RCC. The number of payers and providers who are new to clinical pathways, whether buying or developing their own (e.g., Dana-Farber Cancer Institute’s proprietary pathways program implemented in conjunction with Philips), is also growing. Recent Avalere research has found that over 250 payer and provider organizations are contracting with a pathway vendor or developing an internal pathway program to support oncology treatment decisions.

To evaluate the reach of specific oncology clinical pathways in UC and RCC, Avalere performed a quantitative analysis leveraging 100% Medicare fee-for-service (FFS) claims data to estimate market exposure. Through this analysis, Avalere estimated the relative size of the eligible UC and RCC patient populations impacted by ClinicalPath and Value Pathways, 2 of the most prominent provider-driven pathways programs, to be 18% and 20% of the total patient populations who are taking oncology treatments for these cancer types, respectively. Each pathway includes multiple options for UC and RCC treatments or allows for multiple options with documentation. Moreover, each program has a review process in place for approval of treatments that are not “on-pathway.”

In order to evaluate fully the overall impact of provider-driven pathways on oncology management and patient access to therapies, further research is needed to better understand the following:

  • Breadth of treatment options available on each pathway
  • Organizational incentives to adhere to pathways
  • Intersection with payer-driven pathways and other treatment decision tools
  • Influence of alternative payment models

Avalere has a wealth of experience in oncology clinical pathways and can perform similar market-exposure assessments for other pathways vendors, payer and provider users of pathways, therapeutic areas, and specific product types. For more information, please connect with us.

Methodology

Using a combination of proprietary data and publicly available information, Avalere determined which provider organizations use ClinicalPath or Value Pathways and defined the patients eligible for each pathway. Next, Avalere identified patients diagnosed with advanced UC and RCC within 100% Medicare FFS claims data, and then attributed those patients to provider organizations who use such pathways.

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