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.1 Memorial Sloan Kettering Cancer Center, through a project led by Peter B. Bach, MD, MAPP, has released an interactive cost calculator known as the DrugAbacus.2 These models consider the common elements of cost, benefit value, and an adjustment for toxicities. After the input of values, the tools produce a result that is intended to help stakeholders weigh the cost of drugs versus their expected benefits.
Because we interact directly with patients, physicians, payers, and drug manufacturers, those of us at the pharmacy level are afforded a unique perspective. Increasingly, we see new drugs with escalating price points and payers struggling to balance treatment affordability with out-of-pocket costs and reasonable premiums. Physicians are frustrated with what they may see as interference from insurers, and most concerning is the issue that should be paramount to all—patients struggling with affordability.
Some have suggested that the answer to affordability is as simple as limiting a patient’s out-of-pocket expenses or increasing the availability of patient copay assistance. Although these solutions provide short-term transactional relief, they fail to address the larger issue of rising total costs. Relying too heavily on these solutions can accelerate the spiral of higher prices, which further increases monthly premiums and creates greater financial strain. Families that become unable to afford appropriate insurance face the risk of catastrophic financial consequences as a result of insufficient coverage.
With worldwide spending on cancer drugs hitting an all-time high of $100 billion in 2014 and showing no sign of abating, many payers are feeling a threat to their ability to sustain an affordable benefit design. As a result, they are looking to ensure that healthcare dollars are spent in a way that delivers the biggest impact. Value-based tools are viewed as a logical and necessary step to ensure the continued availability of affordable healthcare.
Patients are also increasingly engaged in decision-making regarding their own healthcare and the resulting financial implications. To the degree that value-based tools increase understanding and enable informed choices, the appropriate use of these tools should be supported.
We should all be encouraged that this growing focus on value versus cost is already delivering on its greatest promise—prompting drug makers, insurers, doctors, and patients to engage and discuss the factors that should determine price.
