The Lynx Group

Economics & Value

Articles about real-world healthcare utilization and costs on Value-Based Cancer Care.
The Triple Aim of better patient care, lower spending by payers, and the maintenance of financially viable practices and hospitals is achievable with condition-based payment models in oncology, said Harold D. Miller, MS, President and Chief Executive Officer, Center for Healthcare Quality and Payment Reform, at the Fifth Annual Conference of the Association for Value-­Based Cancer Care.
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As patients, providers, payers, and policymakers continue to seek ways to assess the value of cancer therapies by balancing clinical benefits and treatment costs, a number of tools have been released to define the value of medicines.
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Gone are the days when patients with cancer were, for the most part, protected from healthcare costs by their medical insurance. According to a recent study sponsored by the National Comprehensive Cancer Network and conducted by Ronan J. Kelly, MD, MBA, MBBCh, Assistant Professor of Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, and colleagues, with high deductibles, escalating copayments, and cost-sharing requirements becoming the status quo, patients with cancer are now, more than ever, feeling the effects of financial toxicity, particularly young patients who are especially susceptible to filing for medical bankruptcy (Kelly RJ, et al. J Oncol Pract. 2015;11:308-312).
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Chicago, IL—An economic analysis presented by Daniel Goldstein, MD, of Emory University, Atlanta, GA, at the 2015 American Society of Clinical Oncology meeting, was conducted to see at what price will necitum­umab (which is currently being reviewed by the FDA for use in metastatic squamous-cell lung cancer) be cost-­effective. According to this analysis, necitumumab will have to be priced at less than $1300 per cycle to be cost-­effective based on the accepted willing­ness-to-­pay threshold of $150,000.
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Chicago, IL—An analysis of chemotherapy infusion by Aetna shows that approximately 75% of their patients still receive chemotherapy in a community oncology setting, suggested Michael A. Kolodziej, MD, National Medical Director for Oncology Strategy, Aetna at the 2015 American Society of Clinical Oncology meeting.
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Chicago, IL—It is not a surprise that targeted therapies are the main drivers of spending on anticancer drugs in the United States. At the 2015 American Society of Clinical Oncology meeting, researchers presented data from several major cancer centers about the cost of targeted therapies.
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Although we all admire and support the efforts put forth by many experts to help quantify the “real” value of cancer medications, they still miss the mark in 2 dramatic ways.
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How can cancer care decisions be based on value? Two champions are starting to add science to this controversial discussion, which will eventually help all stakeholders make more informed decisions.
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Medicare’s Oncology Care Model (OCM) proposes a partial shift in financial risk from Medicare to oncologists. This incentivizes oncologists to use higher-­value, lower-cost services. Information such as the recently released American Society of Clinical Oncology (ASCO) framework to assess new cancer treatment options will likely garner keen interest among providers participating in the OCM or similar programs, to the benefit of providers, payers, and patients.
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The American Society of Clinical Oncology (ASCO) value framework essentially calls for accountability and transparency, which are qualities that are beneficial to providing complete care for patients and to improving positive patient outcomes.
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