COVID-19 and the impact on treatment pathways

Written by Maggie Heinrich on Thursday 7th May 2020

In the ongoing effort to curb the spread of the COVID-19 pandemic and deliver urgent care to those affected, healthcare providers around the world are being forced to review existing treatment pathways. In the UK, new guidelines are also being issued for treatment management to ensure the efficiency and continuity of care, whilst prioritising the safety of patients and medical staff by reducing exposure to potential sources of the novel coronavirus. In effect, procedures and clinic appointments deemed non-essential are being cancelled, postponed or managed remotely via telephone consultations, wherever possible. Patients are also encouraged to manage their health conditions at home, so that their potential exposure to the virus is minimised.

Complex treatment pathways are being changed to allow patients to be managed at home

The need to manage patients away from hospitals as much as possible is also affecting treatment choice. For example, where oral chemotherapy could substitute infusion-based drugs, the oral medication is being recommended for certain cancers including certain types of breast, non-Hodgkin Lymphoma, melanoma, myeloma, neuroendocrine and renal tumours (NICE, 20201). These oral substitutes are being endorsed in cases where the risk of toxicity or neutropenia is high, increasing the need for in-patient treatment. Oral chemotherapy options also reduce the general number of hospital visits patients would typically have to attend to receive intravenous treatment. Similarly, in the case of IBD conditions where patients are particularly susceptible to infection, doctors are being asked to consider initiating subcutaneous injections to new patients requiring anti-TNF treatment, as opposed to commencing them on intravenous equivalents (British Society of Gastroenterology, 20202).

Pharma need to understand the future impact of current pathway changes

Understanding the impact of the changes to existing treatment pathways and their permanence is crucial to mapping out future treatment trends for the pharmaceutical industry. Are the prescribing choices that clinicians are having to make right now temporary, or are they likely to become the new norm as the health crisis continues and beyond? The most recent communication circulated to all healthcare providers in England by Simon Stevens and Amanda Pritchard suggests that the latter might be the case in the UK. Stevens and Pritchard refer to the need to ‘lock in the beneficial changes’ brought about in response to the healthcare crisis such as flexibility, remote working and the use of digital consultations, indicating the direction of change for the delivery of healthcare (NHS England, 20203).

What will the adoption of these new approaches to patient management across different countries mean and how will they influence patients’ behaviours? Will patients be offered the choice to stay on home-based treatments they started during the pandemic or will these decisions be driven by external factors, such as clinical decision or availability of funding? How are the enforced changes in treatment delivery impacting adherence and patient satisfaction right now? Given the choice, will patients go back to infusions or will they prefer to receive their treatments at home going forward? Knowing the answers to these important questions can make a difference for predicting payers’ behaviours and the impact on future market trends. Therefore, engaging in early conversations with prescribers and patients who experienced treatment changes will provide an opportunity to better understand the impact of COVID-19 on treatment needs in the post-epidemic era.

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References

1 NICE (2020). Interim treatment change options during the COVID-19 pandemic, endorsed by NHS England, https://www.nice.org.uk/guidance/ng161/resources/interim-treatment-change-options-during-the-covid19-pandemic-endorsed-by-nhs-england-pdf-8715724381 . Accessed on 30 April 2020.

2 British Society of Gastroenterology (2020). BSG expanded consensus advice for the management of IBD during the COVID-19 pandemic, https://www.bsg.org.uk/covid-19-advice/bsg-advice-for-management-of-inflammatory-bowel-diseases-during-the-covid-19-pandemic/. Accessed on 30 April 2020.

3 NHS England (2020). SECOND PHASE OF NHS RESPONSE TO COVID19. https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/04/second-phase-of-nhs-response-to-covid-19-letter-to-chief-execs-29-april-2020.pdf . Accessed on 30 April 2020.

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