By 2020, costs of cancer care in the United States will reach an estimated $173 billion.1
The question is, what does this buy?
The answer is behind a paradigm shift to quantify value—versus costs—in cancer care to provide what American Society of Clinical Oncology (ASCO) President Peter Yu, MD, calls “truly personalized medicine”.
“We have a very broad definition of value. We are very clear that it is not simply about pricing and cost of therapy, although that is an important element,” Dr. Yu said in an interview with ChemotherapyAdvisor.com at the 2014 ASCO Annual Meeting.
Improving value has unique challenges for oncology. This includes a sense of urgency as many patients with cancer have a poor prognosis and are facing imminent death; the pressure to use the newest technologies/treatment; treatments are expensive, making appropriate cancer care a hardship or unaffordable; treatments can be highly toxic or life-threatening; and providers are often reluctant to switch to best supportive care, even at end of life.2
Currently, ASCO’s Value in Cancer Care Task Force (established in 2007 as the Cost of Cancer Cost Task Force) is charged with developing a framework for assessing relative value of cancer treatment and interventions based on benefits, side effects, and costs.3 In January 2014, ASCO held a leadership summit to address value in cancer care “amid growing concerns about the sustainability of continued increases in the costs of new drugs and technologies used in the diagnosis and treatment of cancer.” The goal of the meeting—which included pharmaceutical representatives, insurance payers, patient advocates, and physicians—was “to initiate a dialogue on the challenge of defining value in cancer care.”4 According to ASCO, specific details will be forthcoming later this year, including a public opportunity for comment on the framework.
Recently, the Hutchinson Institute for Cancer Outcomes Research (HICOR) at the Fred Hutchinson Cancer Research Center, the Seattle Cancer Care Alliance, and a coalition of provider groups, health insurers, and businesses jointly launched a statewide Value in Cancer Care Initiative and, in January 2014, held the first Value in Cancer Care Summit.5 Six value measures were identified6:
- Rate of chemotherapy at end of life
- Use of health care navigator, care coordinator, or case manager
- Documentation of conversation and/or consultation about hospice or palliative care
- Biomarker and molecular testing
- Adherence to primary therapy guidelines
- Unanticipated hospital admission
Gary H. Lyman, MD, MPH, HICOR co-director, told ChemotherapyAdvisor.com that he believes “given the large regional variation in medical practice and resources, it is likely to be with implementation at the regional and local level that we are likely to see the greatest acceptance, uptake, and impact from such efforts.”