Value in Oncology

In the past year, the American Society of Clinical Oncology (ASCO), the European Society for Medical Oncology (ESMO), and the Institute for Clinical and Economic Review (ICER) have introduced frameworks that seek to determine clinical value in relation to cost for a variety of cancer treatments.
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In addition to affecting patient well-being and quality of life, financial toxicity has been shown to worsen survival outcomes because of nonadherence to drug therapy. Although policy interventions, improvements in benefit designs, and adjustments to reimbursement may help reduce costs for patients in the long-term, immediate changes are needed to alleviate financial burden, said Yousuf Zafar, MD, MHS, of the Duke Cancer Institute, Durham, NC, at ASCO 2016.
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An economic analysis of oncology regimens that were previously evaluated in trials conducted by the Canadian Cancer Society Research Institute has shown that the transition from branded to generic drug costs has a considerable impact on the cost-effectiveness and cost-utility of treatment.
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Aggressive end-of-life care for patients with terminal cancer and other illnesses is costly and not recommended. ASCO recommends that patients with terminal cancer should receive palliative care rather than interventions that do not prolong life but do add to suffering.
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Access and adherence to long-term cancer therapies are emerging as major public health issues around the world, as high out-of-pocket costs for oral oncolytics are linked to nonadherence that can directly affect patient outcomes, said Dawn L. Hershman, MD, MS, Professor of Medicine and Epidemiology, Columbia University Medical Center, New York, NY, at ASCO 2016.
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In her presidential address, Julie M. Vose, MD, MBA, Chief of the Oncology/Hematology Division, University of Nebraska Medical Center, Omaha, highlighted the importance of multimodal care and its effect on the quality of care and enhancement of clinical trial participation among patients with cancer.
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The National Academy of Medicine recommends a shared decision-making approach when discussing medical treatments; however, an overview of evidence presented by Terrance Lynn Albrecht, PhD, Associate Center Director, Population Sciences, Karmanos Cancer Institute, and Chief of Oncology, Wayne State University School of Medicine, Detroit, at the 2016 American Society of Clinical Oncology annual meeting suggests that clinicians are not very effective in following this recommendation.
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An international collaborative pilot study found large differences by country in retail prices for 23 cancer drugs, with the highest retail prices in the United States and the lowest in India and South Africa. Higher prices, however, did not mean that the drugs were less affordable, according to lead investigator Daniel Goldstein, MD, Rabin Medical Center, Petach Tikvah, Israel, who presented the results at the 2016 ASCO annual meeting.
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Women with clinicopathologic high-risk breast cancer had nearly a 50% reduction in prescription chemotherapy, with no increased risk for metastatic recurrence when a cancer gene-based assay was used to guide treatment decision-­making, according to new data presented at the 2016 American Association for Cancer Research meeting.
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