Oncology: Pathways to Progress - Pharmaceutical Executive

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Oncology: Pathways to Progress


Pharmaceutical Executive



Dan Paterson, Verastem
Mehmud: From my perspective, guidelines are only a starting point. While they work well for a large proportion of patients, where there is an existing good base of evidence that can be applied, what is necessary is more definitive and precise guidance on how to use them in the clinical setting, including more subjective factors like patient satisfaction and quality of life as well as cost effectiveness. There must be clarity and transparency in the methodology used in making the transition from the evidence-based guidelines of NCCN to the point-of-care issues that are covered in Level I Pathways. We don't want a situation where it all comes down to direct costs [e.g., drug acquisition], which can be very misleading and leads to frustration for providers and their patients. Clarity in the process will allow pharmaceutical companies to ensure that they generate the right evidence to support appropriate positioning and inclusion of their medicines in Level I pathways.

Dan Paterson, Verastem: A physician-driven standard that enforces compliance through peer pressure is a good way to engage around these issues. If you succeed in convincing payers at the macro level that your practicing physicians are providing good care that is also cost effective, then you avoid a whole host of problems. One is that there will be less demand for prior authorizations, where access to a medicine can appear to be determined arbitrarily, and impacted by things like a patient's particular benefit plan or his/her home zip code.

Looney: Much of what we have been discussing so far relates to uptake—translating the evidence so that it is "cooked in" to the pathways and then pushing this out to shape decisions taken at the bedside. Are the conditions ripe for widespread acceptance of pathways as a benchmarking tool that will produce consensus in making patient welfare the focal point of treatment? Oncology does seem to be one of the few therapy areas where pathways and guidelines are actually making a difference in resolving distortions in practice patterns.

Fitzgerald: In the case of cancer care, I think we are indeed ahead of the curve. The McKesson decision support technology is going to accelerate our progress. Where I see danger is the complexities of the US health reform agenda may lead to more efforts to "reinvent the wheel." We already have a guidelines/pathway redundancy issue in this country.


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