The Lynx Group

AVBCC Fourth Conference: Optimizing Value and Stakeholder Integration in Cancer Care

May 2014, Vol 5, No 4

Los Angeles, CA—The Fourth Annual Conference of the Association for Value-Based Cancer Care, held May 6-9, 2014, kicked off 4 days of presentations by oncology stakeholders from across the country, including patients, physicians, pharmacists, nurses, payers, healthcare investors, and drug and diagnostics makers.

The conference was introduced by Co-chairs Gary M. Owens, MD, President, Gary Owens Associates, Ocean View, DE, and Grant D. Lawless, RPh, MD, Associate Professor of Clinical Pharmacy and Pharmaceutical Economics and Policy, University of Southern California, Los Angeles.

The topics at this year’s conference centered around challenges facing all stakeholders in optimizing value in cancer care, and defining the barriers associated with cost, quality, and access to care.

“Balancing the cost–quality equation is one of the major themes we try to tackle in the Association for Value-Based Cancer Care,” said Dr Owens. The total cost of cancer care continues to grow, posing challenges to all oncology stakeholders, including patients, providers, payers, and manufacturers (Table).

Themes in day 1 included proving the value of oncology therapy using comparative effectiveness research, methods and tools for optimal reimbursement for new and emerging technologies, the impact of changing risk models (ie, accountable care organizations, oncology medical homes) on reimbursement of cancer care and traditional pharmaceutical relationships, the use of competitive intelligence to maintain coverage and access, and delivering value and access across multiple regions and nations.

Over the 4 conference days, experts in various areas of cancer care presented data and considered new options for improving patient care and outcomes, including new therapies, a renewed focus on patient-centered care, and new approaches to physician reimbursement.

The marketplace for the pharmaceutical industry is changing, and it represents a changing opportunity, said Dr Lawless. “We’ve seen an evolution among pharma and biotech. We went from the time of the blockbuster model that was all about volume, to the market model where it was having a mix and a matrix of different products…to where we are now, which I call the payer model,” Dr Lawless said. “It’s not just government payers; it’s really that whole payer mix. And the payer mix is changing as well. It’s everything from hospital health systems to countries to regions.” The payer model is patient-centric, and value in this model is based on improv­­ing outcomes and health technology assessment.

Looking Globally for Solutions
Innovation in the pharmaceutical industry is becoming more expensive, and the recovery of investment is becoming more challenging, said Dr Lawless. In the past, margins were high for a number of years. Over time, margins have become narrower over a shorter period of time. “What we’re facing is a challenge of efficiency,” he said. “Oncology is going to be one of the most impacted areas of all. We’re going to look across the globe.”

The response to payer challenges varies by country, and the United States can learn from different models to assess reimbursement and to lower healthcare costs. The US response to these challenges has been healthcare reform, formularies and preferred drug lists, and clinical pathways. In Germany, free market pricing is established for 1 year, after which pricing is negotiated based on cost-effectiveness. Italy has a government medicine agency that operates autonomously and according to cost-effectiveness criteria in managing the value and cost of medicines. In France, the main determinant of a drug’s reimbursement level is its efficacy, and this method has led to substantial government savings. In the United Kingdom, pricing is based on the current National Institute for Health and Care Excellence assessment value.

“China, Japan, South Korea, and other areas that are emerging are also coming up with some unique payment models as well, so the world is changing, and we’re part of it,” Dr Lawless said. “How we look at measuring value at different points in the continuum of care will be an interesting change. One of the things we hear over and over is that it’s fine to have a great and a needy population, but at the point of delivery, does it make a difference and change the outcome?”

Drug review methods generally rely on comparative effectiveness research and cost-utility analyses, but the choice of comparator differs between countries. In Germany, the appropriate comparator for this type of research is suggested by the manufacturer, but is chosen by the government. In the United Kingdom, the comparator is the current best alternative or routine treatment. In the United States, all alternatives are considered using the available data.

In going from regulation to coverage reimbursement decisions, said Dr Lawless, the 4 questions being asked by organizations and government agencies are:

  1. Can it work (is it safe as well as efficacious)?
  2. Does it work (is it effective)?
  3. Does it work better than others (comparative effectiveness among different technologies)?
  4. Is it worth it (outcomes measures at different points in the delivery of care)?

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