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Cost and Value

Posted 6/23/2015

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  This is a recurring theme: the cost and value of cancer drugs. If you have been reading this blog for a while, you have heard some of this before and know that it is part of a larger national movement called Choosing Wisely ( that has been organized by the American Board of Internal Medicine and looks at t cost of drugs and procedures and treatment across all medical specialties.

  My husband chairs the ASCO committee on value and has spent hundreds of hours over the past few years on this important project. The long-awaited article/report from the committee was published in the Journal of Clinical Oncology yesterday, and Lowell spent much of the weekend on the phone with reporters who had seen an advance copy. If you are at all interested in this topic, and you should be because it will eventually affect all of us, here are excerpts and links to several articles:

Cancer Doctors Offer Way to Compare Medicines,
Including by Cost

Alarmed by the rapid escalation in the price of cancer drugs, the nation’s leading oncology society unveiled on Monday a new way for doctors and patients to evaluate different treatments — one that pointedly includes a medicine’s cost as well as its effectiveness and side effects.
The release by the American Society of Clinical Oncology of what it calls its “value framework,” is part of a
change in thinking among doctors, who once largely chose drugs based on their medical attributes alone. The major cardiology societies, for instance, are also now starting to factor cost into their evaluation of drugs.
“The reality is that many patients don’t get this information from their doctors and many doctors don’t
have the information they need to talk with their patients about costs,” Dr. Richard Schilsky, chief medical
officer of the oncology society, said in a news conference on Monday.
He said the price of new cancer drugs now averaged about $10,000 a month, and some cost $30,000 a
month, which can mean prohibitive co-payments even for some patients with good insurance. “Many cancer
patients are facing severe financial strain, even bankruptcy in some cases,” he said.
The value framework envisions considering two costs: the out-of-pocket costs for the patient and the
overall cost of a drug to the health system.

Doctors Propose Tool to Help Gauge the Value of Cancer Drugs
The pushback against soaring cancer drug prices is gaining steam. A leading doctors group on Monday
proposed a formula to help patients decide if a medicine is worth it — what it will cost them and how much
good it is likely to do.
The move by the American Society of Clinical Oncology is the third recent effort to focus on value in
cancer care. Two weeks ago, the European Society for Medical Oncology proposed a similar guide. Last week, Memorial Sloan Kettering Cancer Center in New York posted an online tool suggesting a drug's fair price,based on benefits and side effects.
"We have a broken system" with drug prices rising more than the degree of benefit, said Dr. Peter Bach,
director of the Center for Health Policy and Outcomes at Sloan Kettering. "We hope consumers increasingly
think about value."
New cancer drugs typically cost more than $10,000 a month, and patients are paying a greater share
through higher copays and deductibles.
"We have extraordinarily expensive technology that we have developed but a lot of it doesn't seem to move
the needle that much" in terms of survival, Michael Porter, a Harvard Business School economist, told an
audience at the U.S. oncology group's annual conference last month.

Drug Costing $9,200 Scores Zero on Cancer Doctor Value Scale

The leading group of U.S. cancer doctors created a scoring system for oncology drugs, awarding a zero for
overall benefit to the $9,200-a-month regimen featuring Eli Lilly & Co.’s Alimta.
The formula ranges from 0 to 100 points and was published Monday in the Journal of Clinical Oncology.
It aims to simplify the complex statistics behind cancer medicines into a single “net health benefit” score
that weighs a drug’s ability to extend life or delay progression against potential toxic side effects.
The ultimate goal is to assess many drugs and put the data into a user-friendly mobile software application
that patients and doctors can use at the bedside, said Richard Schilsky, chief medical officer for the
American Society of Clinical Oncology, which convened a task force to assess value.
The scoring system combines efficacy and toxicity data into a single number, with the most weight given
for how much a drug extends survival or delays disease progression. Points are subtracted or added if a
new drug regimen is more or less toxic than the previous standard it was tested against. Drugs for
advanced cancer can get bonus points if they reduce symptoms or lead to treatment-free periods, giving
those medications a potential maximum score of 130.

Top Seller
Lilly’s Alimta, which scored a zero as part of a regimen for advanced lung cancer, was the company’s topselling drug in 2014 with $2.79 billion in revenue. Analysts expect Alimta will continue to generate sales of
more than $2 billion through 2021, according to data compiled by Bloomberg. Lilly spokeswoman Carla
Cox said the company was still reviewing the system and said the assessment doesn’t represent the
intended patient population of people with nonsquamous non-small cell lung cancer.
“What I can say is that tools that make generalizations about the value of cancer medicines in the interest
of cutting costs dismiss the continuous and complex nature of cancer innovation and could threaten future
progress and patient access to better treatments,” she said.


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