Value Propositions

VBCC - February 2015, Vol 6, No 1 - Value Propositions

Medicare Begins Coverage of Lung Cancer Screening with Low-Dose Computed Tomography for High-Risk Beneficiaries

The Centers for Medicare & Medicaid Services (CMS) announced that effective immediately, as of February 5, 2015, Medicare will begin to cover the cost of screening for lung cancer with low-dose computed tomography for beneficiaries who are at high risk for lung cancer based on their smoking history and other risk criteria.

“This is the first time that Medicare has covered lung cancer screening. This is an important new Medicare preventive benefit, since lung cancer is the third most common cancer and the leading cause of cancer deaths in the United States,” said Patrick Conway, MD, MSc, CMS’ Chief Medical Officer and Deputy Administrator for Innovation and Quality.

The coverage is for an annual screening for beneficiaries who are (1) aged 55 to 77 years and are either current smokers or have quit smoking within the past 15 years; (2) have a history of tobacco smoking of ≥30 “pack-years” (an average of 1 pack daily for 30 years); and (3) have received a written order from a physician or a qualified nonphysician provider who meets certain ­requirements.

This new Medicare coverage also includes a counseling visit on the benefits and risks of lung cancer screening. The decision also includes required data collection and specific coverage eligibility criteria for radiologists and for radiology imaging centers, consistent with current national recommendation and evidence-based guidelines.

“We believe this final decision strikes an appropriate balance between providing access to this important preventive service and ensuring, to the best extent possible, that Medicare beneficiaries receive maximum benefit from a lung cancer screening program,” Dr Conway said.

The Centers for Medicare & Medicaid Services; February 5, 2015




NIH Awards $1.08 Million for Breast Cancer Research Using Genomic Sequencing and Computer Modeling to Investigate the Underlying Mechanism of Human Diseases

The National Institutes of Health (NIH) has awarded the University of Texas at San Antonio (UTSA) a $1.08-million grant for breast cancer research that involves genomic sequencing and computer-modeling strategies to investigate what causes breast tissue cells to become cancerous. The research is being conducted by a team of electrical and computer engineering professors. The team will look into the correlation between cancer cells and mRNA methylation, an epigenetic process that oversees the normal functions of human cells. The goal is to discover abnormalities in the methylation process that may explain the development of cancerous cells and other disease processes.

“By bringing together computer engineers who are experts in computational modeling with experts in biology and genome sequencing, we have added a new dimension to the emerging study of mRNA methylation,” said Yufei Huang, PhD, Computer Engineering Professor, at UTSA. “We are going to conduct some truly groundbreaking research over the next few years.” Dr Huang explained that uncovering the role of mRNA methylation in the regulation of the transformation from normal cells to breast cancer cells will provide new insights for the development of more effective therapeutic ­interventions.

“The research to be performed at UTSA through this prestigious NIH grant has the potential to fundamentally change how we see human diseases,” said Daniel Pack, PhD, Chair, Department of Electrical and Computer Engineering, UTSA.

University of Texas at San Antonio; December 18, 2014




Northwestern Onco-SET Introduces Genomics-­Based, Personalized Medicine to All Patients with Cancer

The Robert H. Lurie Comprehensive Cancer Center of Northwestern University, in Chicago, IL, is collaborating with Northwestern Medicine Developmental Therapeutics Institute (NMDTI) and Northwestern Memorial Hospital to launch a new program known as Northwestern Onco-SET (Sequence, Evaluate, Treat) to focus on personalized medicine in oncology by directly connecting patient care and genomics. The focus will initially be on all patients with cancer that is not responsive to available therapy for that cancer.

“Northwestern Onco-SET will help establish Chicago as a national and international leader in precision medicine for cancer,” said Leonidas Platanias, MD, PhD, Director of the Lurie Cancer Center. “This is the first time cancer treatment in Chicago will be offered in a comprehensive, multidisciplinary program using molecularly defined genomic targets as a basis for determining treatment options, including novel early-phase clinical trials.”

Onco-SET will personalize treatment for every patient by sequencing the genetic profile of the patient’s tumors to select appropriate treatment or enter the patient into a clinical trial if no appropriate treatment is available.

“As part of our work with Onco-SET, we are also planning to initiate a pilot program of site-agnostic, pathway-driven tumor clinics,” Dr Platanias said. The goal is to focus on targeted therapies to address that patient’s genetic abnormalities with new targeted therapies on the market or those still in early-stage clinical trials.

“Onco-SET will provide the environment and infrastructure in which we can deliver personalized cancer treatment for patients who currently have very limited options, while accelerating our other research focused on developing novel individually tailored agents,” said Francis Giles, MD, Deputy Director of the Lurie Cancer Center, Co-Chair of the Molecular Tumor Board, and Director of NMDTI. We will be able to learn more about which genomic targets are most important to effectively treat cancer and identify potential targets for which no drugs may currently exist.”

Northwestern Memorial Hospital; February 5, 2015




Hematologic Drugs Offer Value Despite High Costs

A new cost-effective analysis of studies related to oncology and hematologic cancer drugs sheds a new light onto the debate about the high price of novel cancer therapies in the United States, showing that, in many cases, breakthrough therapies for hematologic cancers provide good value for patients, despite their high cost.

“Given the increased discussion about the high cost of these treatments, we were somewhat surprised to discover that their cost-effectiveness ratios were lower than expected,” said lead investigator Peter S. Neumann, ScD, Director of the Center for Evaluation of Value and Risk in Health, Tufts Medical Center, Boston. “Our analysis had a small sample size and included both industry- and nonindustry-funded studies. In addition, cost-effectiveness ratios may have changed over time as associated costs or benefits have changed. However, the study underscores that debates in health care should consider the value of breakthrough drugs and not just costs,” Dr Neumann said.

Using the patient quality-adjusted life-year (QALY) measure to determine acceptable ratios, the research team observed that most ratios were lower or more favorable than thresholds often used in the United States as benchmarks for cost-effectiveness ($50,000-$100,000 per QALY). The median reported cost-effectiveness ratio was highest for chronic myeloid leukemia at $55,000 per QALY, and lowest for non-Hodgkin lymphoma at $21,500 per QALY.

American Society of Hematology Press Release; February 5, 2015

Related Items
Value Propositions - April 2018
VBCR - April 2018, Vol 7, No 1 published on April 17, 2018 in Value Propositions
Value Propositions - October 2017
VBCR - October 2017, Vol 6, No 4 published on October 20, 2017 in Value Propositions
Value Propositions - August 2017
VBCR - August 2017, Vol 6, No 3 published on August 23, 2017 in Value Propositions
Value Propositions - June 2017
VBCR - June 2017, Vol 6, No 2 published on June 29, 2017 in Value Propositions
Value Propositions - April 2017
VBCR - April 2017, Vol 6, No 1 published on May 3, 2017 in Value Propositions
Value Propositions - December 2016
VBCR - December 2016, Vol 5, No 6 published on January 5, 2017 in Value Propositions
Value Propositions - October 2016
VBCR - October 2016, Vol 5, No 5 published on November 2, 2016 in Value Propositions
Value Propositions - August 2016
VBCR - August 2016, Vol 5, No 4 published on August 25, 2016 in Value Propositions
Value Propositions - June 2016
VBCR - June 2016, Vol 5, No 3 published on July 7, 2016 in Value Propositions
Value Propositions - April 2016
VBCR - April 2016, Vol 5, No 2 published on May 14, 2016 in Value Propositions
Last modified: February 19, 2015
  • Rheumatology Practice Management
  • American Health & Drug Benefits
  • Value-Based Cancer Care
  • Value-Based Care in Myeloma
  • Value-Based Care in Neurology