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What is Value in Cancer Care

Posted 6/2/2016

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  Value has become a very important buzz word in Cancer World, actually in Health Care World in general. To begin, there are almost as many definitions of value as there are people who are asked. It means something different to a pharmacist than to an oncologist than to a patient. Since I think from and speak from the patient perspective, I also know that there are many different definitions among patients. What I most value may not be so important to you.

  As ASCO begins its' annual meeting in Chicago, there will be a lot of attention paid to this question as it relates to the skyrocketing costs of cancer drugs. It is not uncommon for a new drug to carry a price tag of $10,000/month and some cost three times that. Of course insurance companies are balking at this expense and we are all needing reassurance of their value. Patients are seeing huge increases in co-pays and deductibles, and I hear from at least one patient each week who just cannot afford the new treatment that has been recommended. 

  ASCO has just released a new updated value framework to help oncologists and patients make the best possible decisions about treatments. Full disclosure: my husband has chaired this ASCO committee for years and is first author on the paper that was just published in the Journal of Clinical Oncology. This means that I have had a front row seat to observe the countless hours and conversations and struggles that have gone into this project and the passionate wish to deliver the best possible solution.

  This is a quick summary of their article:

ASCO Releases an Updated Value Framework
Author: Surabhi Dangi-Garimella, PhD

The American Society of Clinical Oncology (ASCO)’s Value in Cancer Care Task Force has published an updated value framework that can help clinicians and patients assess the relative value of cancer therapies that have been compared in clinical trials.
The conceptual framework, published last year right after ASCO’s annual meeting, was aimed at easing the shared decisionmaking process for patients and oncologists as they weigh the numerous treatment options available to them. ASCO claims that its framework incorporates elements of clinics benefit, toxicity, and symptom palliation—all drawn from clinical trial data—to develop a net health benefit (NHB) score. Patients are also provided information on the cost of the regimens to help understand the financial impact of their treatment.
The revised framework, published today in the Journal of Clinical Oncology, defines value as a combination of clinical benefit, side effects, and improvement in patient symptoms or quality of life in the context of cost, according to an associated press release. The current updates are based on the feedback that ASCO received—from patients, patient advocates, physicians, representatives of the pharmaceutical industry, and other members of the cancer community—during a 60-day comment period following the release of the value framework.

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It is absolutely vital that the patient voice be heard loudly in this conversation and that any consideration of value and outcomes begins and ends with the patient, not with dollars. This is an excellent article from Hem/Onc Today about this:

Value in cancer care must ‘start with patients, not dollars’
by Cameron Kelsall

A quote: An open, honest discussion between oncologists and their patients about efficacy, toxicity and costs is necessary to ensure value, according to Lowell
E. Schnipper, MD, professor of medicine at Harvard Medical School, clinical director and chief of hematology and oncology at Beth Israel Deaconess Medical Center, and a HemOnc Today Editorial Board member.
Schnipper chairs ASCO’s Value in Cancer Care Task Force. The panel — previously called the Task Force on Cost in Cancer Care — was renamed to show money is not the only metric by which value is measured.
In this spirit, the task force last year released a conceptual framework to measure the value of a cancer treatment based on its “net health benefit” score, which accounts for clinical benefit and toxicity.
“It is most important to relate what our patients are getting in terms of clinical benefit to the cost of medications,” Schnipper said. “We are seeing substantial costs in terms of price per month for many new anticancer drugs, which are by no means necessarily curative. It is our obligation to find a metric agreeable to oncologists that represents the clinical impact of a new treatment or combination of treatments that can then be presented as options to the patient. That way, a patient will know what a therapy costs, but also how much or how little it is likely to benefit them.

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