When insurers adopt evidence-based clinical guidelines for the use of radiation therapy in treating consumers with breast cancer, their network radiologists are three times faster to adopt these guidelines.
Anthem, Inc. subsidiaries, HealthCore, an outcomes research company, and AIM Specialty Health, a specialty management company, presented this information at the ASCO Annual meeting on Saturday, June 2 in Chicago.
The research is an update of a study originally conducted in 2013 with the University of Pennsylvania and Anthem, demonstrating the positive impact that coverage guidelines can have on clinical practice. The research compared consumers that were subject to new clinical guidelines and other consumers who were not. The results showed less overtreatment, which not only reduces costs to the healthcare system but reduces side effects by advocating for shorter regimens that have been shown to be less toxic and produce fewer side effects, such as redness, burning, itching and pain.
The original study published online in the Journal of the American Medical Association showed that in 2013 only one in three women with early stage breast cancer who were eligible for a shorter course of whole breast radiation therapy, or hypofractionated treatment, actually received it. Most women received the longer duration of radiation despite evidence that using three to four weeks of treatment is as effective as six to seven weeks in women meeting specific criteria.
HealthCore recently updated the original study it conducted in 2014 with the University of Pennsylvania and Anthem. The previous study showed that only 11 percent of those women that were recommended hypofractionated treatment based on Choosing Wisely guidelines, actually got it in 2008, in the first year studied. However, by the end of 2016, 64 percent of the appropriate candidates for the procedure received the shorter course of therapy.
Anthem health plans began implementing changes to their clinical guideline in January, 2016, to make the shorter course of therapy the standard of care. Anthem’s new clinical guideline provides for coverage for members for 16 fractions or three to four weeks of whole breast cancer radiation therapy for those who qualify. The guideline also outlines specific clinical scenarios where 25 –28 fractions or five to six weeks of whole breast treatment are appropriate.
Preliminary data comparing those members whose plans approved the use of the clinical guideline changes in 2016 showed that use of the less toxic and shorter regimens increased by 29 percent, compared to 9 percent among those members with plans that did not choose to implement the guideline change.
The Anthem clinical policies are consistent with those established by the American Society of Radiation Oncology, which also lists the frequency of whole breast radiotherapy as one of the top 10 radiology measures patients and their doctors should question as part of the Choosing Wisely campaign.
ASTRO recently updated their guideline by removing age, tumor size and prior chemotherapy restrictions regarding who should be considered for hypofractionated treatment. Anthem’s clinical guideline is being amended to reflect this change and maximize the number of patients benefiting from short course breast irradiation.
This is just one example of how companies like Anthem, AIM and HealthCore make a positive difference in the lives of consumers – by reducing their exposure to toxic side effects and saving healthcare costs.