The cost of caring for cancer rose from $27 billion in 2009 to $90 billion in 2008, yet unwarranted variation in that care persists across centers, providers, and patients. As yet, there is little evidence on comparative effectiveness of the different management options and on the value provided by different healthcare services, but this is expected to change, said Elena B. Elkin, PhD, assistant attending outcomes research scientist at Memorial Sloan-Kettering Cancer Center, an invited discussant of several cost-effectiveness studies at ASCO.
More than $1 billion in the stimulus package is earmarked for comparative effectiveness research (CER), and these findings will be used to inform clinical guidelines, provider reimbursement, coverage decisions, and cost-sharing.
Healthcare reform and the mandated expansion of insurance coverage provide “demand and opportunity” for investigating the impact of insurance on cost and value of care. But in the interpretation of CER, she cautioned that “correlation does not equal causation,” and said that although there are “promises” inherent in the move toward CER there are pitfalls as well. In analyses of treatment options, for example, it can be hard to adjust accurately for comorbidity and other inevitable confounders, she pointed out.
The hope is that studies funded through the stimulus package and healthcare reform legislation will have rigorous methodology and be based on “sound assumptions,” she said. In addition, the study process should be transparent, should allow for updates to incorporate new evidence and options, and should encourage the dissemination of information to all stakeholders.
