NCCN Guideline Adherence Lowers Total Cost of Care for Cancer Patients

Adherence to National Comprehensive Cancer Network (NCCN) guidelines during treatment correlates to lower total costs of care (TCOC) for breast and colon cancer patients, according to findings presented at ASCO 2022 by CVS Health.

The NCCN’s clinical guidelines aim to enhance the safety of cancer treatments by incorporating the latest clinical research and trial results to enable clinicians to provide evidence-based personalized patient care, anticipate and manage adverse events, and reduce medication errors. The NCCN guidelines cover over 97 percent of all cancers prevalent in the US, and they are continuously updated to reflect the most current research. NCCN guidelines are considered the gold standard for cancer treatment.

CVS Health researchers have previously found that NCCN concordance was associated with reduced costs for lung cancer patients. The research presented at this year’s ASCO meeting in June sought to determine if there were similar reductions for breast and colon cancer patients.

In the breast cancer study, the researchers retrospectively examined patients throughout the US with breast cancer at a large national Medicaid, Medicare, and commercial insurer from Jan. 1, 2019, to Dec. 31, 2020. They identified NCCN adherence by examining pharmacy and medical claims data. NCCN regimen adherence was defined by whether the entire prescribed treatment regimen matched NCCN Level 1 and 2a guidelines for treatment.

TCOC and cost components were measured on a 2-to-1 matched population of concordant and non-concordant patients. Researchers used logistic regression to eliminate possible bias and differences in characteristics that could impact cost by matching patients based on age, socioeconomic status, comorbidity, and treatment type.

A total of 315 patients were matched. TCOC for the concordant group — beginning from the first treatment to 180 days after — was significantly less overall than that of the non-concordant group. Specifically, TCOC was 43 percent less for Medicare patients, 28 percent lower for commercial fully insured patients, and 25 percent lower for commercial self-insured patients treated with NCCN-concordant regimens compared with their non-NCCN-concordant counterparts.

The colon cancer study involved a similar study setup with 937 patients. The Medicare patients in the guideline-concordant group saw a 33 percent reduction in TCOC compared with the non-concordant group.

But no significant differences were seen in TCOC among commercial fully insured and commercial self-insured patients in the two groups.

TCOC differences between concordant and non-concordant groups were primarily driven by medical chemotherapy spending, as concordant patients spent 26 percent less than their non-concordant counterparts.

In both studies, NCCN concordant patients spent significantly less than non-concordant patients, indicating that NCCN adherence can lower costs for cancer patients.

The researchers stated that their findings showcase the importance of evidence-based guidelines in treatment determinations. But they also noted that more extensive studies are needed to validate and expand this research.

These studies are part of CVS Health’s ongoing efforts to use NCCN guidelines to advance precision medicine.

In an interview with HealthITAnalytics last year, CVS Health Divisional Head of Enterprise Oncology Roger Brito, DO, discussed how the organization had leveraged NCCN guidelines as part of its Transform Oncology Care program.

According to Brito, using NCCN guidelines helps clinicians improve patient outcomes and enhance the patient journey.

“By incorporating the guidelines into our provider platform, we enable oncologists to select the best regimens – and get them approved in a very timely manner. Therefore, the patients are getting the treatments at the right time," Brito said. "Expediting the time to treating the patient is really important and impactful."