Economics & Value

The emergence of various tools for assessing value or, more to the point, drug costs—both direct and indirect—by leaders within the oncology and hematology community is highly commendable. Those of us on the managed care side of healthcare look forward to practical and meaningful tools in helping patients, pro­viders, employers, and health plans navigate through the complexity of oncology drug therapy and drive better informed decision-making.

Value-based oncology was one of the high-profile topics at the 2015 American Society of Clinical Oncology (ASCO) meeting. It is something that is discussed widely in print and on social media. It is certainly top of mind for payers, doctors, policymakers, business leaders, and, in particular, patients.

With all the focus in the media on cancer drug costs, let alone within the oncology community, the American Society of Clinical Oncology (ASCO) has released its much-anticipated value framework.

Value versus cost is becoming an increasingly common question, particularly when evaluating new cancer drugs. The American Society of Clinical Oncology recently published its initial value framework to assist in assessing the value of new cancer therapies.

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.