Maximizing Value and Quality in Gynecologic Cancer Care—Work in Progress

VBCC - September 2014 Vol 5, No 7 - Value in Oncology
Wayne Kuznar

Chicago, IL—Comparative effectiveness research (CER) and cost-effectiveness analyses have helped to define value as it relates to gynecologic oncology, said speakers during an education session on maximizing value and quality in gynecologic cancer care, at the 2014 American Society of Clinical Oncology meeting.

The rising cost of healthcare has forced an examination of value. Value is defined as desirable health outcomes achieved per monetary unit spent, suggested Laura J. Havrilesky, MD, MHSc, Associate Professor of Obstetrics and Gynecology at Duke University Medical Center, Durham, NC.

Although CER is being used to determine value in cancer care, the cost of the therapies being compared in such studies is rarely considered, because of research funding restrictions, Dr Havrilesky said.

By contrast, a cost-effectiveness analysis compares the cost and effectiveness of 2 current therapies, adding an essential component to value measurement.

Implications of Cost-Effectiveness Analyses for Cancer Care
In oncology, the measure of cost-effectiveness is usually related to patient overall survival (OS), which is expressed as a dollar amount per quality-adjusted life-year (QALY) gained.

“Drug cost is critical,” said Dr Havrilesky. “Targeted therapies may be more cost-effective than global treatment with expensive therapeutics.”

In ovarian cancer, “testing to select individuals likely to benefit from targeted interventions is potentially cost-effective when compared with global treatment,” Dr Havrilesky said.

Intraperitoneal chemotherapy for ovarian cancer has risen to the level of standard therapy based on improvement in OS compared with intra­venous chemotherapy and an in­cremental cost-effectiveness ratio of ‹ $40,000 per QALY gained, which is well within the limit that is accepted as cost-effective.

Although adding bevacizumab (Avastin) to a standard chemotherapy regimen can improve progression-free survival by several months, the incremental cost-effectiveness ratio exceeds $400,000 per 1 year of progression-free survival, she noted. The cost of beva­cizumab would have to decline to 25% of its current reimbursement to be cost-effective in this setting.

A predictive test to determine treatment with bevacizumab could possibly improve its cost-effectiveness, with an incremental cost-effectiveness ratio of approximately $130,000 per QALY. Until then, high-profile biologic agents do not appear to meet the standard societal willingness-to-pay thresholds.

Gynecologic oncologists must consider the possible toxicity level and the inconvenience of added treatments and the potential additional out-of-pocket expenses when considering adding novel therapies to the treatment regimen, deciding for or against maintenance chemotherapy, assigning treatment for recurrent disease, and when making the decision to move a patient to end-of-life care, Dr Havril­esky pointed out.

Guideline-Based Care Improves Survival
William A. Cliby, MD, Professor of Obstetrics and Gynecology at the Mayo Clinic, Rochester, MN, presented the evidence-based measures of quality in gynecologic surgery, again using ovarian cancer as an example. Overall, the cancer care delivery system in the United States is in crisis, he said, because cancer care is often not as patient-centered, accessible, coordinated, or evidence-based as it could be.

Adherence to National Comprehensive Cancer Network (NCCN) guideline care is a reasonable outcome measure. Following NCCN guidelines in surgical staging and in selecting chemotherapy regimens improves survival in patients with ovarian cancer.

However, “most patients don’t receive guideline care,” said Dr Cliby. “The application of existing best practices is the most cost-effective form of quality improvement.”

Case volume and guideline care have been shown to be important drivers of survival in this disease, but 25% of patients with ovarian cancer are treated across 65% of centers, all with fewer than 8 cases per center. Similar themes are observed with the care of patients with cervical cancer, he noted.

Related Items
Hypermobility Syndrome Underrecognized, Requires Team-Based Management
Wayne Kuznar
VBCR - October 2016, Vol 5, No 5 published on November 2, 2016 in Rheumatic Diseases
Neuropathies in Rheumatic Diseases Encompass Wide Spectrum of Diagnoses
Wayne Kuznar
VBCR - October 2016, Vol 5, No 5 published on November 2, 2016 in Rheumatic Diseases
Patients with Rheumatoid Arthritis Cite Improvements in Pain, Quality of Life as Treatment Goals
Wayne Kuznar
VBCR - October 2016, Vol 5, No 5 published on November 2, 2016 in Rheumatoid Arthritis
Celecoxib Demonstrates Better Results than Acetaminophen in Patients with Low Back Pain
Wayne Kuznar
VBCR - August 2016, Vol 5, No 4 published on August 25, 2016 in Back Pain
Cost of Drugs and Affordability Don’t Always Jibe
Phoebe Starr
VBCC - July 2016, Vol 7, No 6 published on July 13, 2016 in Value in Oncology
The New World of Biosimilars
Meg Barbor, MPH
VBCC - June 2016, Vol 7, No 5 published on June 17, 2016 in Value in Oncology
Entrectinib Shows Strong Activity Against a Range of Rare Solid Tumors with Molecular Abnormalities
Wayne Kuznar
VBCC - June 2016, Vol 7, No 5 published on June 17, 2016 in Emerging Therapies
Promising Antitumor Activity of ODM-201 in Metastatic Prostate Cancer
Wayne Kuznar
VBCC - June 2016, Vol 7, No 5 published on June 17, 2016 in Emerging Therapies
Chemotherapy Use in Breast Cancer Declines with Gene-Based Assay
Charles Bankhead
VBCC - June 2016, Vol 7, No 5 published on June 17, 2016 in Value in Oncology
Updated NCCN Guideline Calls for EGFR Mutations Testing in All Patients with NSCLC
Wayne Kuznar
VBCC - June 2016, Vol 7, No 5 published on June 17, 2016 in Lung Cancer
Last modified: September 19, 2014
  • Rheumatology Practice Management
  • American Health & Drug Benefits
  • Value-Based Cancer Care
  • Value-Based Care in Myeloma
  • Value-Based Care in Neurology