Integrating Gene Therapy Into Value-Based Care

Medical advances emerge swiftly, and sometimes surprisingly. The rapid number of new products approved by the Food and Drug Administration (FDA) for the treatment and care of patients with cancer perfectly illuminates this fact. It also suggests why clinical pathways and other methods of value-based care have become so vitally important to ensure that patients receive the right care, at the right time, for the most advantageous value. The 2017 Clinical Pathways Congress addressed this issue in many different ways, and coverage of that event can be found in this issue (page 11) for those who were unable to attend.

On the same topic, the current issue also includes a great interview with Steve Miller, MD, MBA, the chief medical officer of Express Scripts (page 14). Dr Miller recently blogged about the FDA’s approval of Kymriah, a potentially revolutionary treatment option for young adult patients with acute lymphoblastic leukemia (ALL). Studies of Kymriah, a breakthrough gene therapy that is only administered once, showed overall response rates exceeding 80% in this population, which has experienced historically poor survival outcomes. However, the product carries a hefty price tag of $475,000. Dr Miller explains why the traditional payer model may need to be adjusted to bear the weight of such costly but necessary therapies.

The rising trend of gene therapy is further addressed later in this issue by Chadi Nabhan, MD, MBA, FACP, and colleagues from Cardinal Health (page 31). Dr Nabhan and colleagues conducted a study of community oncologists’ perceptions on the acceptability of chimeric antigen receptor T-cell (CAR-T) therapies, long believed to be the next big thing in the oncology world. They found that only a relatively small percentage of community doctors described themselves as unlikely to prescribe CAR-T therapies once they are approved by the FDA, and that cost did not appear to be a hindrance for prescribing patterns. However, nearly half of the doctors queried suggested they would refer their patients to academic medical centers for CAR-T therapy.

Elsewhere in the issue, Gena Cook, BA, explores the potential for clinical pathways in symptom management (page 36). Symptom management during active cancer treatment can sometimes be characterized by extreme variability, and can often lead to costly expenditures, including unnecessary emergency department visits. Ms Cook suggests that a unified pathway approach to symptom management may reduce this variability while maximizing the time of health care professionals through standardization. She considers the successes of The Center for Cancer and Blood Disorders in Texas in implementing successful symptom management clinical pathways.

Medicine changes rapidly, but you can always count on Journal of Clinical Pathways for the latest information on value-based care!