Building a Transparent Framework for Predictable Cost of Care in Oncology Pathways

In a session at the 2025 Clinical Pathways Congress and Cancer Care Business Exchange (CPC+CBEx), Gordon Kuntz, president of Kuntz Consulting, and Carole Tremonti, RN, MBA, senior director of provider partnerships at ConcertAI, presented progress from Phase 2 of the Predictable Cost of Care initiative. The initiative is a cross-stakeholder effort to define and quantify the true, incremental costs associated with cancer therapies beyond just drug acquisition. With participation from pathway developers, payers, clinicians, and pharmaceutical sponsors, the project aims to create a standardized, transparent methodology for assessing the cost impact of oncology treatments at the point of pathway inclusion and clinical decision-making.

For decades, cost discussions in oncology pathways have centered narrowly on drug prices—typically using average sales price (ASP) or wholesale acquisition cost (WAC). But as Tremonti emphasized, “When they talk about costs today, they’re really talking about the drug cost.” The Predictable Cost of Care initiative aims to expand this view to include the full range of predictable, knowable costs associated with a therapy—such as administration, side effect management, pre-treatment testing, and follow-up monitoring.

The rationale is clear: while the total cost of care is often cited as a key metric, it’s a retrospective measure and cannot guide real-time decisions. Instead, the initiative focuses on building a model for predictable incremental cost—the anticipated costs directly attributable to a therapy when delivered appropriately.

“Total cost of care is also retrospective. That means we cannot measure it until after it’s already happened,” Tremonti noted. “Let’s put our quality improvement hats on and not let perfect be the enemy of good.”

Phase 1 of the project, completed in 2023, established the foundational scope: defining which cost elements should be included and which should be excluded. For example, standard-of-care procedures like routine genomic testing for lung cancer were excluded, since they should be conducted regardless of the therapy chosen. The emphasis is instead on incremental costs, the additional resources and services required specifically because of a given treatment.

This approach enables fairer comparisons between therapies in the same indication or line of therapy and creates a shared cost lexicon across stakeholders.

Kuntz elaborated on the foundational logic: “Administration of a drug—check the package insert. Side effects and their frequencies? In the label. Recommended follow-up? Also included. That was the starting framework.”

In 2024, the working group moved into Phase 2, shifting from conceptual design to practical implementation. Efforts focused on standardizing units of cost (eg, cost of managing a Grade 3 adverse event), identifying trustworthy data sources (eg, Medicare fee schedules), and establishing a repeatable model to assign cost values in a transparent and reproducible way.

One major focus in Phase 2 is capturing the cost of managing significant adverse events, particularly those that drive downstream utilization or require hospitalization. The group is working toward defining unit-based cost estimates for managing Grade 3 or higher toxicities using Common Terminology Criteria for Adverse Events (CTCAE) as a reference framework.

Each toxicity scenario is broken down into components—such as medication, visits, and infusions—and assigned a cost based on Medicare reimbursement rates. The resulting estimates are meant to be scalable, independently verifiable, and applicable across settings.

“What does it cost to manage Grade 3 diarrhea? It’s not just a number—it’s at-home meds, IV fluids, infusion time, provider assessment,” Tremonti explained. “Each of those has a unit cost. That creates cost units.”

This structure will enable pathway developers, clinicians, and even pharma to present cost profiles of therapies that include much more than the label price, helping committees and clinicians better understand the true resource intensity of their options.

While the initial use case was for pathway inclusion decisions, the framework is already being recognized for its broader utility. Beyond pathway committees, predictable cost data can support internal institutional budgeting, value-based contract negotiations, and even patient education about time burden or visit frequency. Tremonti emphasized this multi-use potential: “One of the surprises has been the breadth of use cases.”

The team aims to complete the initial model framework by the end of 2025. It will be made public, free, and open, with governance for iterative updates and stakeholder feedback.

“We’re building a model. Pharma partners will test it. The model will be public, published in the Journal of Clinical Pathways,” Tremonti said. “This gives pharma a way to prove their cost-savings claims—if they’re true.”

The session acknowledged that progress hasn’t been easy. Despite good intentions, collecting side effect cost data has been unexpectedly challenging due to internal compliance concerns and hesitations about perceived intent.

“We thought pharma would just hand it over,” Tremonti said. “But organizational barriers, compliance/legal blocks, and misunderstanding of intent slowed things down.”
Still, with expanded participation from pharmaceutical companies, community clinicians, and integrated delivery networks (IDNs), Phase 2 continues to evolve. The team is calling for additional collaborators—particularly those willing to “test drive” the model with real-world drug submissions and share feedback.

Kuntz encouraged engagement: “Compare decisions with and without predictable cost data. Review our categories. Help us make it better.”

As oncology care becomes increasingly complex, treatment decision-making must balance efficacy, safety, and cost in real time. The Predictable Cost of Care initiative represents a major step toward developing a standardized, stakeholder-accepted methodology for evaluating the financial footprint of cancer therapies—before those costs are incurred.

Reference 
Kuntz G, Tremonti C. Predictable cost of care working group phase 2 update: building the model. Presented at the Clinical Pathways Congress; September 6, 2025; Boston, MA.