Using real-world evidence to realize the promise of value-based care


Bruce Feinberg, DO

Vice President
Chief Medical Officer
Cardinal Health Specialty Solutions

Over the past year, Cardinal Health Specialty Solutions has published numerous studies on the real-world treatment patterns in leukemia and lymphoma care, and on the economic impact of care on patients.

Building upon this body of work, Cardinal Health Specialty Solutions will publish a new set of clinical studies focused on renal cell carcinoma at the American Society of Clinical Oncology (ASCO) meeting May 29- June 2, 2015. Here, Dr. Bruce Feinberg talks about this research, and why having access to real-world evidence is an important component of value-based care.

Q: The industry has historically relied on clinical trials to guide treatment protocols.  Why is it important to collect real-world evidence?

A: Oncologists have known for more than a decade that clinical trials do not accurately reflect how cancer treatment happens in the real world.  Less than three percent of adults with cancer participate in these trials, and those who do participate tend to be younger, healthier and often times more committed to their treatment plans than patients in every day clinical practice. As a result, clinical trials don’t tell us how treatment is adopted and used in the general population.  

As we transition to a healthcare system that is focused on value-based care, understanding patterns of care and how healthcare resources are being utilized in ‘real life’ will be critical.

Q: Over the past year, Cardinal Health has published numerous studies on real-world treatment patterns in both solid and liquid tumors. How would you describe the purpose and focus of this research?

A: We believe that health economics and outcomes research (HEOR) is critical to improving the industry’s understanding of real-world oncology care and the true value that cancer treatments deliver. HEOR can provide patients, providers, manufacturers and payers with the kind of real-world treatment and outcomes data that can help them transition to a value-based care model.

Our work in renal cell carcinoma, which we’re highlighting at ASCO 2015, builds on an increasingly formidable body of research that we have cultivated over the past three years. It focuses on patterns of care, resource utilization and global cost of care; and how clinical pathways, medical homes and new reimbursement models can impact each.  We believe this kind of research is critically important to improving the quality and reducing the costs of oncology treatment.

Q: Tell us more about the renal cell carcinoma studies published at this year’s ASCO conference.

A: Our research in renal cell carcinoma is particularly important because of the rapidly expanding arsenal of biologic therapies available to treat the disease. We view this rapid growth in treatment options as a bellwether of sorts for modern, post-clinical-trial disease treatment. Renal cell carcinoma has seen two new drug types with seven new drug approvals, in a short amount of time – with almost no head-to-head, real-world testing. This lack of real-world data has left patients, providers and payers longing for clarity when it comes to how best to prioritize and sequence these medications. The renal cell carcinoma studies we’re presenting at ASCO provide real-world treatment data that can help physicians get closer to that clarity.

We have seen this same situation unfold in chronic lymphocytic leukemia (CLL), melanoma and lung cancer in just the past year, and we also see it in drug classes like tyrosine kinase inhibitors, PD-1 pathway inhibitors and EGFR inhibitors, to name but a few. As the number of therapeutics available to treat chronic diseases continues to expand, we’re facing a new paradigm in cancer care. And that new paradigm demands a new type of real-world research to help ensure that the right medications are being prescribed to the right patients, in the right sequence, at the right time.  

Q: How do you anticipate that real-world evidence will change the practice of oncology in the coming years?

A: As I’ve discussed in a prior post – we know that as human beings, physicians engage two different forms of decision making: intuitive and deliberate. In medicine, these two ways of thinking are often in conflict. Ourintuition tells us one thing and our deliberate research tells us another. I think that physicians will increasingly look to real-world clinical evidence to augment clinical trial data when making treatment decisions; and to test their intuition when it comes to treatment. Ultimately, I think this kind of data will help physicians make more rational, evidence-based treatment decisions that better serve the patient and make better use of resources.

I also think real-world evidence will also impact payers and pharmaceutical manufacturers. It can help manufacturers develop better, more targeted launch and marketing programs for their medications – programs that more accurately reflect market needs. This kind of research can also help manufacturers validate the impact their medications have on patients in real-world settings, which I believe can ultimately help increase the likelihood that payers will provide adequate reimbursement for the cost of the medications.

Real-world clinical data will also increasingly be used by payers, as they develop new, value-based reimbursement models.

Get the full abstracts of Cardinal Health Specialty Solutions research being featured at ASCO 2015.