As a result of increasing health care costs, a shift in oncology care toward a value-based practice model has drawn interest from payers. Pathways are a subset of guidelines intended to provide standardized cancer drug prescribing by clarifying decisions regarding efficacy, safety, and cost. But major predictors of compliance with recommendations for clinical pathways are unknown.

Samyukta Mullangi, MD (Memorial Sloan Kettering Cancer Center, New York, NY), presented “Predictors of compliance with payer-led oncology clinical pathways” at the 2022 ASCO Quality Care Symposium, a retrospective cohort study that used administrative claims linked with prior authorization data of Anthem commercial and Medicare Advantage members. Mullangi and colleagues identified 17,584 members aged 18 or older who had been diagnosed with melanoma or with breast, lung, colorectal, bladder, kidney, uterine, or pancreatic cancer and who were being treated with a first-line regimen in the metastatic setting between July 2018 and October 2021.

Pathway compliance (PC)—defined as whether a patient’s anti-cancer drug regimen is also an Anthem pathway-endorsed regimen—was the study’s primary outcome. The investigators built a logistic regression model with stepwise backward selection to identify patient, physician, practice, geographic, and temporal factors associated with PC.

The study showed that of the 17,584 total patients, the treatment period returned 11,277 (64%) observations of patients with PC (48.1% male, mean [SD] age 60.7 years [11]) and 6,307 (36%) without PC (45.1% male, mean [SD] age 60.4 years [11.6]). In adjusting the analyses, investigators found that the odds of PC decrease over time and with variation by malignancy. Any inpatient (OR = 1.32, 95% confidence interval [CI] 1.22–1.43) or emergency department utilization (OR = 1.21, 95% CI 1.12–1.31) in the 6-month baseline period was associated with higher odds of PC.

The study also revealed that the odds of PC increased with a higher share (median or above vs below median) of Anthem patients per physician (OR = 1.12, 95% CI 1.04–1.20), and that participation in the Oncology Care Model (OCM) tended to lead to higher odds of PC (OR = 1.13, 95% CI 1.04–1.23).

Mullangi and colleagues found that PC was observed in almost two-thirds of cases among patients with metastatic disease who were treated in the first-line setting. They also found that PC was associated with the penetration of Anthem patients, and that increased PC participation in OCM was also associated with increased PC.

Source

Mullangi S, Chen X, Pham T, et al. Predictors of compliance with payer-led oncology clinical pathways. Presented at: the 2022 ASCO Quality Care Symposium; September 30- October 1, 2022; Chicago, IL, and virtual; Abstract 7.