Dr. Faisal Mehmud, GlaxoSmithKline: How will you position these new Value Pathways in tandem with the different evidence based guidelines, based on the US Oncology
Network Level I Pathways, and especially the relevant NCCN Guidelines?
Denduluri: The two information streams actually complement each other. The Value Pathways built from the previous Level I Pathways include
a focus on economic issues pertinent to providers and payers. The NCCN Guidelines continue to provide a panel of evidence-based
treatment options, but do not assess costs to patients and payers and lack a "how-to-do" framework on the actual administration
of care. McKesson Specialty Health, which supports The US Oncology Network, has a useful electronic health record, iKnowMed,
which integrates these different strands of evidence. Between iKnowMed and the new quality support tools in development with
NCCN, we can put changes immediately into effect throughout the community practices.
Jorge Puente, Pfizer
Dr. Jorge Puente, Pfizer: I am curious how your pathways address the situation—quite common in the oncology space—where there is absent or unconvincing
clinical data to weigh against the high cost of a particular therapy. On what basis then do you determine what might be the
recommended or most cost effective treatment option?
Denduluri: If there is no evidence of real clinical benefit from trial data and the cost of the drug is in the six figure range, then
we do not include it on the pathway, and usually dissuade any prescribing of that treatment; exceptions are made on a selective
basis, and we make sure the drug payments are pre-authorized.
Dr. Mark Rutstein, ImClone Systems: If the evidence is built around the patient, do you provide specific metrics to evaluate his/her quality of life? More specifically,
are patient reported outcomes part of your assessment?