Economics & Value

Washington, DC—Although significant advancements in oncology research, development, and treatment have improved cancer care, they have been accompanied by rising drug costs, and differences in drug availability and delivery worldwide. These trends will continue into 2020, according to Douglas Long, Vice President, Industry Relations, IMS Health.

Washington, DC—An innovative, value-based approach to managing the cost of oncology care moves away from drug-spending volume toward the appropriate use and quality of drug therapy, said Alan Lotvin, MD, Executive Vice President, Specialty Pharmacy, CVS Health, Woonsocket, RI, at the Sixth Annual Conference of the Association for Value-Based Cancer Care.

Washington, DC—Treatments and technologies for cancer care are becoming increasingly expensive, fueling a need to define and improve value. As a result, the American Society of Clinical Oncology (ASCO) is refining its value framework that supports informed shared decision-making between doctors and patients and considers the clinical benefit, cost, and toxicity of cancer treatments. The goal is to have a tool that can customize information for each patient.

Washington, DC—An opportunity for value enhancement from the drug manufacturer’s perspective includes the improved use of data to meet the needs of stakeholders, especially the patient. Data that are generated should support the value of the manufacturer’s therapies in light of newly established value-based models, which often rely on quality metrics, for example, that are not obvious from clinical trials. Finally, wraparound services can add to a drug’s value and help to distinguish it from a competitor’s drug.

Washington, DC—Oncology care is facing rising costs that will demand a transformation from a fee-for-service reimbursement model to a value-based, shared-risk incentive plan for Medicare and commercial insurance plans. Bruce Pyenson, FSA, MAAA, Principal and Consulting Actuary, Milliman, New York, NY, provided an overview of the cost trends of cancer treatment costs at the Sixth Annual Conference of the Association for Value-Based Cancer Care.

Society meetings, such as the recent American Society of Hematology (ASH) annual meeting, generate a lot of clinical-related excitement regarding new treatment options, protocols, and pathways for hematologic cancers.

Medicare is poised to incorporate new quality metrics as a guide for payments. At ASH 2015, Helen Burstin, MD, MPH, Chief Scientific Officer, National Quality Forum, Washington, DC, discussed the need for measures and reporting systems that reflect patient care and care coordination.

“Centers of Excellence” (COEs) is not a new concept in healthcare. The underlying hypothesis is that providers who specialize in a particular procedure or service will produce superior, predictable outcomes. Payers have developed COE networks to manage cost and quality for complex medical conditions for more than 2 decades, steering volume to high-performing providers in exchange for discounted contractual rates. Under significant pressure to reduce the burden of cancer spending, payers are beginning to make bold network decisions, including narrowing networks, but they need precision tools to ensure that quality of care is uncompromised, and even improved, while reining in unsustainable cost trends.

Copenhagen, Denmark—Current follow-up strategy for patients with prostate cancer was found to be the least cost-effective approach in an analysis conducted in Europe.

The treatment of patients with brain metastases involves issues of controlling recurrence, side effects, and costs.