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Evernorth: 3 Actionable Insights To Help Health Plans Improve Cancer Care

Immune checkpoint inhibitors are effective cancer treatments, but are expensive. Understanding the least-costly settings for administering treatments, leveraging genomic testing and following evidence-based guidelines can help health plans optimize cancer care, according to Evernorth Research Institute.

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The use of immune checkpoint inhibitors (ICIs), which help patients’ immune cells destroy cancer cells, is growing: 12.1% of oncology patients received ICIs in 2021, a 47.5% increase from 2018, according to a new Evernorth Research Institutereport.

While the medications are effective, the amount spent on them globally is growing, reaching $37.3 billion in 2022, compared to $360 million in 2011 when they launched.

“The introduction of ICIs has been a game changer in cancer treatments,” said Dr. Bhuvana Sagar, senior medical principal leading clinical innovation at Evernorth, in the report. “When ICIs are prescribed and administered in an optimal manner, they can provide significant benefits, markedly improving survival rates in comparison to other therapies.”

Evernorth Research Institute analyzed utilization and cost data from 47.8 million people for the report. The organization listed three actionable insights for health plans to help them advance cancer care:

1. Cost differs by infusion setting:About two-thirds of ICI treatments are administered at hospital outpatient clinics. But the average cost of treatment in this setting is $157,000 per patient annually, versus $87,000 when administered in a doctor’s office, Evernorth found.

“The cost difference is associated with a far higher drug cost for these patients,” said Urvashi Patel, Ph.D., vice president of the Evernorth Research Institute, in the report. “Our research didn’t see any differences in the number of infusions or the size of the doses. This represents an opportunity to control spending on these important treatments without affecting the quality of care.”

2. Genomic testing and health disparities have an impact:Since not all patients need ICIs, genomic testing is needed to determine which patients are the best fit for these treatments. However, this isn’t always done: 30% of those treated with metastatic lung cancer medication pembrolizumab did not receive genomic testing beforehand, according to Evernorth.

In addition, patients with lower incomes, lower average educational attainment and limited transportation were less likely to receive genomic testing. Only 24% of this population underwent testing.

Those who were not tested were also more likely to stop ICI therapy. About 53% of patients who did not receive genomic testing stopped the medications after the fifth treatment, versus 44% of those who did receive testing.

3. Following evidence-based guidelines can reduce wasteful spending:美国食品药品监督管理局和国家综合cer Network recommend that ICI treatment for advanced stage non-small cell lung cancer lasts 24 months or less. In addition, astudyfound that “indefinite immunotherapy” does not improve patients’ chances of survival.

But Evernorth found that 12.2% of patients treated with pembrolizumab for metastatic lung cancer received treatment for 24 to 30 months, 5.3% received treatment for 30 to 36 months and 4.6% received treatment for more than 36 months. This shows “an opportunity to reduce waste by stopping treatment at an early but appropriate time,” the report stated.

In addition, Evernorth recommends reducing waste by “utilizing supportive care therapy instead of aggressive treatments for patients entering end-of-life scenarios, for example those in hospice. These alternative options can increase quality of life, making their last days more comfortable while minimizing financial hardships.”

Photo: Getty, erhui1979

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