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ASCO’s Net Health Benefit: A Palliative Care Regimen Scores Higher than Active Treatment

VBCC - August 2015, Vol 6, No 7 - VBCC Perspectives
Pamela Pelizzari, MPH
Bruce Pyenson, FSA, MAAA
Principal & Healthcare Consultant
Milliman, Inc
New York, NY

Medicare’s Oncology Care Model (OCM) proposes a partial shift in financial risk from Medicare to oncologists. This incentivizes oncologists to use higher-­value, lower-cost services. Information such as the recently released American Society of Clinical Oncology (ASCO) framework to assess new cancer treatment options1 will likely garner keen interest among providers participating in the OCM or similar programs, to the benefit of providers, payers, and patients.

The ASCO framework provides a relatively straightforward way to compare the value of cancer therapies. The scoring system, which is based on toxicity, clinical benefit, and other factors, leads to a summary representation of­­ the net health­­ benefit of the therapy.1 Although the framework does not yet have an end-­user interface, it is easy to see how these scores could be used in shared decision-making between patients and ­oncologists.

Of note, ASCO’s framework directly addresses palliative care, and the net health benefit for a palliative regimen can exceed that of an active-­treatment regimen under the current scoring methodology. A hypothetical example is given in the Table, where, even with a doubling of survival under active treatment, the palliative regimen scores higher than the active treatment regimen—62 versus 54, respectively.

Table

The ability to compare values for palliative regimens with those for active treatment will be a powerful tool for the emerging risk-sharing arrangements between oncologists and payers. We look forward to future iterations of the framework.




Reference

  1. Schnipper LE, Davidson NE, Wollins DS, et al. American Society of Clinical Oncology statement: a conceptual framework to assess the value of cancer treatment options. J Clin Oncol. 2015 Jun 22. Epub ahead of print.
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Last modified: August 18, 2015
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