The Role of Oncologists in Defining the Value of Cancer Therapy

VBCC - August 2015, Vol 6, No 7 - VBCC Perspectives
Michael Kolodziej, MD
National Medical Director
Oncology Solutions
Aetna
Hartford, CT

It is the best of times and the worst of times in oncology. It is the best of times, because the basic understanding of cancer biology has advanced dramatically and is resulting in real changes to the way we treat cancer. It is the worst of times, because the price tag may not fit in the budget.

There is little question that cancer care is expensive, and that the cost trajectory is unsustainable. And the reason the cost of care is so expensive is multifactorial, and certainly not just because of the cost of chemotherapy. But many of the new breakthrough agents are being launched at a very high price.

Payers are in an awkward position with respect to these prices, because of the general paradigm that FDA-approved cancer therapies are “covered benefits,” and there is little or no negotiation on price. This is true whether the new therapy truly produces a great outcome or not: coverage is independent of value.

A long history exists in Europe of formal value assessment that informs coverage policy, like NICE (National Institute for Health and Care Excellence), but enthusiasm has lagged for this approach in the United States. In the past several months, a groundswell of support has taken place for oncologists tackling this value assessment. Exactly why this has occurred is subject to debate, but issues regarding limited access, financial toxicity experienced by patients, or just fairness have all contributed.

The transparent, objective processes of evaluation used by the National Comprehensive Cancer Network, the American Society of Clinical Oncology, and Memorial Sloan Kettering Cancer Center are all constructs to bring value into the discussion. The individual tools are all slightly different and represent an initial iteration of how technology assessment could be implemented. They all use the components of efficacy and toxicity in the context of cost. And they are all imperfect.

They do not formally consider patient preferences. They do not consider the total cost of care. But they do begin a dialogue that should occur between patients and physicians as part of shared decision-making. These tools also should prompt a dialogue between society and the innovators about the fair price of innovation. And these tools should stimulate thinking among drug manufacturers about max­­imizing the therapeutic benefit of the new medications being brought to market.

The willingness of physicians to act as stewards of scarce healthcare resources will benefit everyone. Arguing about how expensive it is to develop a drug, and setting the price according to what the market will bear, benefits no one. And patients with cancer need new approaches that improve their outcomes at a fair price.

Related Items
The NCCN Evidence Blocks and Clinical Practice Guidelines: Identifying Truth
Robert W. Carlson, MD, Al B. Benson III, MD, FACP
VBCC - March 2016, Vol 7, No 2 published on March 21, 2016 in Online First, VBCC Perspectives
The NCCN New Tool to Assess Value Discourages Patients’ Hope
Robert Goldberg, PhD
VBCC - November 2015, Vol 6, No 10 published on November 12, 2015 in VBCC Perspectives
AstraZeneca Commentary on Oncology Value Tools
Diane Sullivan
VBCC - October 2015, Vol 6, No 9 published on October 17, 2015 in VBCC Perspectives
Emerging Tools for Assessing Value: Pros and Cons
Kirby J. Eng, RPh
VBCC - August 2015, Vol 6, No 7 published on August 18, 2015 in VBCC Perspectives
ASCO’s Value Framework a Powerful Tool for Shared Decision-Making
Neil B. Minkoff, MD
VBCC - August 2015, Vol 6, No 7 published on August 18, 2015 in VBCC Perspectives
ASCO’s Value Framework Promoting Accountability and Transparency
Joseph Morse
VBCC - August 2015, Vol 6, No 7 published on August 18, 2015 in VBCC Perspectives
ASCO’s Net Health Benefit: A Palliative Care Regimen Scores Higher than Active Treatment
Pamela Pelizzari, MPH, Bruce Pyenson, FSA, MAAA
VBCC - August 2015, Vol 6, No 7 published on August 18, 2015 in VBCC Perspectives
Addressing the Value of New Cancer Treatment Options Using the ASCO Model
Philip E. Johnson, MS, RPh, FASHP
VBCC - August 2015, Vol 6, No 7 published on August 18, 2015 in VBCC Perspectives
The Missing Elements in Our Value-Based Care Discussions
Kevin Cast
VBCC - August 2015, Vol 6, No 7 published on August 18, 2015 in VBCC Perspectives
ASCO’s and MSKCC’s Efforts to Address the Cost of New Cancer Treatments
Dan McCrone, MD
VBCC - July 2015, Vol 6, No 6 published on July 21, 2015 in VBCC Perspectives
Last modified: August 18, 2015
  • Rheumatology Practice Management
  • American Health & Drug Benefits
  • Value-Based Cancer Care
  • Value-Based Care in Myeloma
  • Value-Based Care in Neurology