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ASCO Aims to Score New Cancer Treatments on Value

Framework includes cost as well as clinical benefit

In the context of cancer care, do high costs and novel treatments lead to better value? And what does “value” really mean?

To answer those questions, the American Society of Clinical Oncology (ASCO) has published an initial version of a conceptual framework for assessing the value of new cancer treatments based on clinical benefit, side effects, and cost. Eventually, the framework will become a tool for physicians and patients to use to help guide their cancer-treatment decision making.

Lowell Schnipper, MD, chair of the ASCO Value in Cancer Care Task Force, says ASCO embraced the general concept that “value” is the quality of the service delivered and the outcome in relation to its cost. With this in mind, data about the clinical benefits and toxicity of each treatment regimen are used to calculate a combined net health benefit (NHB) score, which represents the added benefit that patients can expect to receive from the new therapy compared with the current standard of care.

Adverse effects are also considered. If a new treatment doubles survival but is much more toxic than standard treatment, that needs to be factored in, Schnipper says. Those factors, taken together, represent the NHB. “Bonus points” are given for factors in the advanced cancer setting that are indicators of better health, such as symptom or pain relief.

The NHB score is presented alongside cost information; a low NHB score with high out-of-pocket and acquisition costs would point to lower value. Conversely, high costs might be justified if the NHB score is also very high.

Why not integrate cost into the NHB and come up with a single evaluation? Schnipper says it’s because there are so many other, variable costs associated with cancer care that are nearly impossible to calculate or predict, such as lost wages, hospitalizations, emergency department visits, and physician costs.

“The costs of cancer care are far more, and more extensive, than just the medications involved,” he says.

Once the comment period is over, Schnipper says his team will “huddle” and make needed changes to the framework. They have already begun talking with software developers to design a Web- and/or mobile-based tool that uses the framework’s variables and that would be pre-populated from the prevailing medical literature with the results of studies that looked at the survival, toxicity, and costs of cancer drugs.

Such a tool would allow a patient and doctor to come up with the value for several different therapies at the patient–doctor interface. It would also allow patients to have a say in their cancer care in relation to what they value. Perhaps someone wants to miss as little work as possible, or a pianist might want to avoid a drug that causes neuropathy so that she could keep playing.

Sources: HealthLeaders Media; July 9, 2015; and JCO; June 22, 2015.

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