ASCO Unveils ‘Value Framework’ for Evaluating Cancer Treatments
On Monday, the American Society of Clinical Oncology unveiled a new "value framework" to help physicians and patients evaluate cancer treatments based on the medications' costs, effectiveness and side effects, the New York Times reports. The framework was published in the Journal of Clinical Oncology.
According to the Times, ASCO released the framework amid concern over the quick escalation of cancer drug costs. For example, ASCO CMO Richard Schilsky said the monthly cost of new cancer medications now averages about $10,000, with some reaching monthly costs of about $30,000. Such costs can be prohibitive for patients who are required to pay copayments for the medications. Schilsky said, "Many cancer patients are facing severe financial strain, even bankruptcy in some cases" (Pollack, New York Times, 6/22). Further, most patients "confront these decisions right now without the benefit of an explicit way of looking at" cost and benefit information, he said, adding, "That's what we're trying to provide" (Rice, Modern Healthcare, 6/22).
The framework calls for providers and patients to consider two different costs for cancer drugs:
- The out-of-pocket costs for which patients will be responsible; and
- The overall cost of the drug to the health care system.
ASCO noted that evaluating the drugs' overall costs to the health care system could place providers in a role of stewarding societal resources. However, the organization said it does not think such a role conflicts with providers' duties to their patients.
Medications' net health benefits are computed based on clinical trial data. As many as 80 of the drugs' net health benefit points come from their effectiveness at extending lives, delaying cancer advancements or shrinking tumors. Another 20 points can be added or subtracted depending on the drugs' side effects. An additional 30 bonus points can be added if the drugs relieve any cancer symptoms or allow patients to forgo treatments for periods of time. The framework lists drugs' costs separately (New York Times, 6/22).
Currently, the framework only contains information on treatments for:
- Advanced lung or prostate cancer;
- Advanced multiple myeloma; and
- A common type of breast cancer (Marchione, AP/Miami Herald, 6/22).
According to the Times, physicians are not required to use the framework (New York Times, 6/22). The framework is open for public comment until Aug. 21, while the group advances with similar plans for other types of cancer (AP/Miami Herald, 6/22).
According to the Times, it will take a while to input data on the costs, effectiveness and side effects of each cancer drug and to convert the framework into a system that physicians can use on computers and mobile devices.
Some Current Treatments Do Not Fare Well
Under the framework, some cancer treatments currently on the market did not fare well. For example:
- Roche's Avastin, when combined with chemotherapy, received a net health benefit of 16 out of a possible 130 points when used as a first-attempt treatment for advanced lung cancer, with a monthly cost of $11,907.97, compared with $182.09 for just chemotherapy; and
- Eli Lilly's Atlima, when used in the same manner, had zero health benefit, with monthly costs reaching more than $9,000, compared with about $800 in monthly costs for comparable medications.
Lee Newcomer, senior vice president of oncology at UnitedHealthcare, said the framework "allows the patient and the doctor to at least talk through the issues" surrounding certain medications, whereas "[b]efore, the information wasn't there." According to Newcomer, UnitedHealthcare is working on a similar initiative in which the insurer beginning this month will require oncologists to get approval before administering cancer drugs (New York Times, 6/22).
Meanwhile, Lowell Schnipper, chief of Beth Israel Deaconess Medical Center's cancer unit, said the evaluations will spur different reactions from different patients. For example, he noted one drug may have better survival rates, but could have worse side effects. "There is that kind of tradeoff in much of what we offer patients," meaning each individual will have to make their own value decisions, he said (AP/Miami Herald, 6/22).
MSKCC Unveils Online Value Tool
Peter Bach, director of the hospital's Center for Health Policy and Outcomes, created the tool, which uses a number of factors -- such as a drug's side effects, how much it costs to develop and the extra years of life it can provide -- to determine a reasonable price for the treatment. The calculator lets users analyze more than 50 cancer drugs. Specifically, the tool shows:
- A drug's actual per-bottle costs and the value-based price, which is determined by variables adjusted by the user;
- The value of an additional year of life, which can be set between $12,000 and $300,000; and
- Other factors, such as a "toxicity discount," which reduces the price based on the severity of a drug's side effects, and development costs, which are also adjustable.
Bach said he believes drugmakers have too much control over pricing. He noted, "We could have a value-driven system for pricing cancer drugs and probably other drugs," calling his tool a "first draft of how to do it" (Loftus, Wall Street Journal, 6/18).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.