Los Angeles, CA—Can comparative effectiveness research (CER) be used for determining value in cancer care? At the Fourth Annual Conference of the Association for Value-Based Cancer Care, C. Daniel Mullins, PhD, Chairman, Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, discussed this topic (see also article in the September issue of this journal) on the challenges of applying CER into value-based oncology therapy.
CER and Value in Oncology
“We’re all trying to figure out what is this thing called value. We’re trying to figure out which drugs to pay for, and how long to pay for them. What does this mean in terms of CER?” Dr Mullins asked.
He noted that healthcare payers are becoming more comfortable with CER methods and are gaining a better understanding of how CER can be used to make informed healthcare decisions.
“Most of the payers who talk to me off the record admit they don’t have a problem paying for value-based medicine,” Dr Mullins stated. “In the future, I think this greater comfort with CER is going to have an impact on the way decisions are made,” Dr Mullins stated.
There is an increasing demand for real-world evidence in research, Dr Mullins said, while admitting that the aspects of “real world” also need to be defined.
Better guidelines on how to obtain a broader patient population in trials are necessary. “We will get to the way medicine is practiced in the real world, but we will preserve the integrity of the clinical trial,” he predicted. “I think that’s near term.”
Dr Mullins believes that there will be increasing demands for more appropriate comparators for studies using CER. Healthcare decision makers want to have a say in what the comparators will be. And testing of comparators needs to be done more fairly. Instead of testing comparators as they are labeled for use by the FDA, Dr Mullins said that decision makers want them tested as they are actually used in the medical community.
The use of add-on drugs versus replacement drugs is a newer trend in oncology. Concerns about the value of additional medications can be addressed with CER.
One of the more difficult issues facing oncologists is stopping a treatment when it is being used beyond its benefit. “This is an issue we have to deal with, where we recognize that the patient is a decision maker, that there is a joint decision-making process, and how we can get to value by stopping treatment when it no longer has value,” Dr Mullins reasoned.
He asserted, “If we can handle these issues in the near run, I think CER has a place in really giving us value-based medicine.”
Dr Mullins foresees that the effective use of CER in oncology can shape clinical guidelines, determine sequencing of drug treatments, and help define meaningful improvement in outcomes.