Quality and value-focused albumin-bound paclitaxel decision support for pancreatic, lung, and breast cancer in southeastern United States.

Abstract

246 Background: Albumin-bound paclitaxel is FDA approved as single agent for breast cancer, in combination with carboplatin for non-small cell lung cancer (NSCLC), and with gemcitabine for pancreatic cancer. Oncology Analytics (OA) is a cancer care decision support group comprised of board-certified oncologists, interacting with more than 2,800 cancer doctors in the Southeastern U.S. We have been making oncologists aware of comparative efficacy data, and the relative values of albumin-bound paclitaxel vs other taxanes. We hypothesized our work has impacted albumin-bound paclitaxel use in these diagnoses with improved cost effective care and value enhancement. Methods: We analyzed all albumin-bound paclitaxel requests for FDA approved indications from April 2013 to June 2014. Requests withdrawn by the treating oncologist after OA consultation were compared with albumin-bound paclitaxel persistence over these five consecutive quarters. Financial outcomes of voluntary oncologist withdrawal of albumin-bound paclitaxel-based therapy in favor of another taxane were calculated as per standard Medicare reimbursement rates. Results: Over the entire 15 month span, we received a total of 265 evaluable albumin-bound paclitaxel requests, on a total of 181 patients. Ninety-two percent (155/168) of requests for albumin-bound paclitaxel with gemcitabine in pancreatic cancer were automatically approved by Oncology Analytics’ web based software. One third each of the requests for breast cancer (12/37, 32.43%) and NSCLC (21/60, 35%) were withdrawn by the requesting MD after OA consultation. Changing albumin-bound paclitaxel to another taxane reduced pharmaceutical costs by approximately $1,124,115 for these 15 months, or $74,941.00 monthly. Conclusions: When paclitaxel or docetaxel are safe and effective alternatives to albumin-bound paclitaxel, OA consultation enhances cancer care quality and value.