title: Clinical Pathways: Management of Quality and Cost in Oncology Networks in the Metastatic Colorectal Cancer Setting.
abstract: Via Pathways (clinical pathways for cancer) provide evidence-based guidance for specific patient presentations based on the merit of efficacy, then toxicity, and finally cost (if efficacy and toxicity are comparable). We evaluated the impact of a change to the guidance in the metastatic colorectal cancer (mCRC) setting across two large, integrated health networks.
  
  
  
  Cetuximab and panitumumab were determined to have equal efficacy in the treatment of mCRC with no significant difference in toxicity based on recent data from key clinical studies. A cost analysis using Centers for Medicare and Medicaid Services average sales data determined a cost advantage for panitumumab. A substitution of panitumumab for cetuximab in the clinical pathway for all mCRC lines of therapy was initiated as of August 2014.
  
  
  
  In the preimplementation period, 86 (93.5%) and six (6.5%) treatment selections were for cetuximab and panitumumab, respectively. After the pathway change was implemented, 13 (18.1%) and 59 (81.9%) treatment selections were for cetuximab and panitumumab, respectively. The change in prescribing habits was rapidly altered by the pathway change. The estimated annualized cost savings for the two health networks resulting from the response to the pathway change was $711,021.
  
  
  
  This study demonstrates that clinical pathways can act as a tool to assist oncology practices in decreasing costs and quickly responding to changing treatment paradigms by providing clinicians with consensus-driven treatment recommendations that incorporate the most up-to-date clinical trial results, toxicity considerations, and regimen cost information.
authors.affiliation: University of Pittsburgh Medical Center Cancer Center; Via Oncology, Pittsburgh, PA; and Indiana University Health, Indianapolis, IN.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Ellis
authors.affiliation: University of Pittsburgh Medical Center Cancer Center; Via Oncology, Pittsburgh, PA; and Indiana University Health, Indianapolis, IN.
authors.forename: Bert H
authors.initials: BH
authors.lastname: O'Neil
authors.affiliation: University of Pittsburgh Medical Center Cancer Center; Via Oncology, Pittsburgh, PA; and Indiana University Health, Indianapolis, IN.
authors.forename: Martin F
authors.initials: MF
authors.lastname: Earle
authors.affiliation: University of Pittsburgh Medical Center Cancer Center; Via Oncology, Pittsburgh, PA; and Indiana University Health, Indianapolis, IN.
authors.forename: Stephanie
authors.initials: S
authors.lastname: McCutcheon
authors.affiliation: University of Pittsburgh Medical Center Cancer Center; Via Oncology, Pittsburgh, PA; and Indiana University Health, Indianapolis, IN.
authors.forename: Hans
authors.initials: H
authors.lastname: Benson
authors.affiliation: University of Pittsburgh Medical Center Cancer Center; Via Oncology, Pittsburgh, PA; and Indiana University Health, Indianapolis, IN.
authors.forename: Melinda
authors.initials: M
authors.lastname: Krebs
authors.affiliation: University of Pittsburgh Medical Center Cancer Center; Via Oncology, Pittsburgh, PA; and Indiana University Health, Indianapolis, IN.
authors.forename: Kathy
authors.initials: K
authors.lastname: Lokay
authors.affiliation: University of Pittsburgh Medical Center Cancer Center; Via Oncology, Pittsburgh, PA; and Indiana University Health, Indianapolis, IN.
authors.forename: Amanda
authors.initials: A
authors.lastname: Barry
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000066491:Clinical Decision-Making; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D019091:Critical Pathways; D019468:Disease Management; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D058990:Molecular Targeted Therapy; D009362:Neoplasm Metastasis; D011787:Quality of Health Care
chemical_list: D000970:Antineoplastic Agents