Oncology Treatment and Care, The Role of Value-based Frameworks

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Multiple value frameworks were developed to help providers, institutions, and payers determine the value of cancer treatment.
Multiple value frameworks were developed to help providers, institutions, and payers determine the value of cancer treatment.
The following article features coverage from the 2017 Hematology/Oncology Pharmacy Association (HOPA) Annual Conference in Anaheim, California. Click here to read more of Cancer Therapy Advisor's conference coverage.

Multiple value frameworks were developed to help providers, institutions, and payers determine the value of cancer treatment, though each framework has its own strengths and weaknesses.

At the 2017 Hematology/Oncology Pharmacy Association (HOPA) Annual Conference, Jason Bergsbaken, PharmD, BCOP, the pharmacy coordinator at University of Wisconsin Health in Madison, discussed the role of value-based care in oncology.1

Dr Bergsbaken noted that cancer outcomes are improving, though costs are rising. “Ultimately, these increased costs are passed on to our patients,” he said.

Increasing costs are due to rising drug prices, changing population demographics, and perverse payment incentives.

Five value frameworks were proposed to address value-based questions: the American Society of Clinical Oncology (ASCO) Value Framework, the European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS), National Comprehensive Cancer Network (NCCN)'s Evidence Blocks, the Institute for Clinical and Economic Review (ICER), and the Memorial Sloan Kettering Cancer Center (MSKCC) DrugAbacus.

Suwhicha Limvorasak, PharmD, BCOP, illustrated how the ASCO framework produces a clinical benefit score and toxicity score, which, when combined with bonus points, result in a net health benefit score. It incorporates patient value and clinical trial data, though can be difficult to calculate, and different therapies cannot be compared across a disease setting.

The ESMO-MCBS considers the strength of the evidence, the threshold of the hazard ratio for the primary endpoint, the severity of toxicities, and quality of life. This framework can be used only for solid tumors.

The NCCN Evidence Blocks consider costs, supporting data, safety, and strength of data, forming a 5-part score. “It can be considered somewhat subjective because it's not based on a rigorous review of clinical data, but actually based on polling that occurs with the NCCN panel members,” said Debbie Stern, RPh, the senior vice president of medical oncology and specialty drugs of eviCore Healthcare in Bluffton, South Carolina.

The ICER framework provides more of the health system value of therapies and can be used as the basis for price negotiations and coverage decisions. It cannot be calculated by individuals, but is published by the Institute of Medicine and is not available for all agents.

Ms Stern highlighted that calculating many of the scores for the different frameworks can be highly time-consuming. Providers and institutions can, however, select the framework that works best for their specific setting, or evaluate information from multiple frameworks to identify the value of anticancer agents.

RELATED: Mitigating Slow Accrual Among Clinical Trials in Oncology

The uptake of the frameworks remains low, with estimates of expected future use ranging from 9% to about 50%. As more stakeholders participate in value-based care and there is a shift to value-based reimbursement, though, the uptake may increase.

Read more of Cancer Therapy Advisor's coverage of the 2017 Hematology/Oncology Pharmacy Association (HOPA) Annual Conference by visiting the conference page.

Reference

  1. Bergsbaken J, Limvorasak S, Stern D. Value of cancer care—which model is best? Lecture presented at: 13th Hematology/Oncology Pharmacy Association Annual Conference; March 29-April 1, 2017; Anaheim, CA. 

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