VBCC Perspectives

The high costs of specialty medications and the burden they place on individual patients and on the healthcare system overall are the media topics du jour. Cancer drugs are often cited as examples of unrestrained medication costs, so it is not surprising that the oncology community has responded by proposing alternative pricing models for cancer treatments based on the incremental value they provide.

The American Society of Clinical Oncology (ASCO) value framework and Memorial Sloan Kettering Cancer Center (MSKCC)’s DrugAbacus are 2 recent examples of an increasing trend of value-­based modeling to assess pharmaceuticals. Of particular interest, these methodologies represent some of the first efforts to incorporate a systematic approach to value specific to oncology. Xcenda, an AmerisourceBergen company, has previously reported on the increasing shift to value-based care with the Department of Health & Human Services and select large US payers.¹ Outside of the United States, single-payer systems in Europe have taken an even more aggressive approach to value-based models, going as far as to quantify the value of human life, and then to measure the use of a drug versus its ability to prolong life in a demonstrable way.

The relative value of cancer care has become the major debate in oncology over the past few years. The rising costs of treatment, along with increasing out-of-pocket costs for patients, have sparked a debate about what is “reasonable” treatment for all involved. As a nonprofit patient assistance foundation, Patient Services provides financial assistance to patients who have great challenges in accessing their treatments because of the high costs. Of note, most of those who receive assistance from our foundation are insured.

Given the number of oncology agents introduced over the past 5 years, and the corresponding rise in costs, it is little surprise that multiple organizations are reacting with methods to assess value. Although payers have historically been the default for assessing value to determine formulary coverage, the most recent entrants of the American Society of Clinical Oncology (ASCO), with its value framework, and Memorial Sloan Kettering Cancer Center (MSKCC), with its DrugAbacus, into this arena represent providers of oncology care. Historically pegged as solely focused on clinical evidence and seeking effective therapy at all costs, the focus by providers on the value of cancer care is increasing.

In 2012 and 2013, the American Society of Clinical Oncology (ASCO) published 2 sets of 5 key opportunities to improve value in cancer care as part of a multispecialty project, called Choosing Wisely. As a supervisor for a process that reviewed more than 15,000 hematology and oncology treatment requests in 2013, we were able to observe oncologists who followed ASCO’s advice, and those who were either unaware of Choosing Wisely or who chose to disregard it. Although the recommendations were not universally followed, they were a tremendous step forward in advancing value-based oncology treatments.

We understand that the financial sustainability of cancer care is a serious issue as cancer diagnoses around the world continue to rise. We commend those organizations seeking to address the issue of value in cancer care, which is an incredibly difficult, multifaceted challenge.

The American Society of Clinical Oncology (ASCO) has introduced its conceptual framework to “Assess the Value of Cancer Treatment Options,” with the laudable objective to “assist physicians and patients in assessing the values of a new drug treatment.” As released, the ASCO framework has the potential to confound oncologists, in some instances, as follows.

There has been talk regarding pricing in healthcare for a number of years, so the recent move by the American Society of Clinical Oncology (ASCO) and by Memorial Sloan Kettering Cancer Center (MSKCC), discussed in this issue of Value­-Based Cancer Care, is certainly a big deal, but is hardly surprising.

In the face of escalating costs of cancer drugs, the American Society of Clinical Oncology (ASCO) rightly asks, what is the value of these new medicines?

Rising to a level of equal status with cancer providers is a tall order for patients with cancer, yet it is precisely the intent of the Meaningful Use Stage 3 proposed standards that are set to take effect in 2018 (ie, patient-reported outcomes), as well as the value-based care initiatives. Providers need to drop their resistance and contemplate the following benefits of patient centricity.