VBCC Perspectives

A recently published perspective in Value-Based Cancer Care criticized the National Comprehensive Cancer Network (NCCN) Evidence Blocks initiative. Regrettably, that perspective is extremely misleading and is full of innuendo and misuse of statistics.
In October, the National Comprehensive Cancer Network (NCCN) released its first set of “flash cards” or “Evidence Blocks” as a tool for evaluating treatment decisions, seeking to solve a drug cost problem that does not exist, by adding to a problem that does: insurers shifting the cost of cancer treatment to patients. In so doing, the NCCN could inadvertently increase the rate at which patients with cancer choose assisted suicide.
As patients, providers, payers, and policymakers continue to seek ways to assess the value of cancer therapies by balancing clinical benefits and treatment costs, a number of tools have been released to define the value of medicines.
The American Society of Clinical Oncology (ASCO) is to be commended for its recently published statement on a conceptual framework to assess the value of cancer therapies. This marks an important, meaningful step forward as clinicians recognize the financial implications of choosing therapies.
It is the best of times and the worst of times in oncology. It is the best of times, because the basic understanding of cancer biology has advanced dramatically and is resulting in real changes to the way we treat cancer. It is the worst of times, because the price tag may not fit in the budget.
The emergence of various tools for assessing value or, more to the point, drug costs—both direct and indirect—by leaders within the oncology and hematology community is highly commendable. Those of us on the managed care side of healthcare look forward to practical and meaningful tools in helping patients, pro­viders, employers, and health plans navigate through the complexity of oncology drug therapy and drive better informed decision-making.
The American Society of Clinical Oncology (ASCO) value framework essentially calls for accountability and transparency, which are qualities that are beneficial to providing complete care for patients and to improving positive patient outcomes.
How can cancer care decisions be based on value? Two champions are starting to add science to this controversial discussion, which will eventually help all stakeholders make more informed decisions. Peter B. Bach, MD, MAPP, of Memorial Sloan Kettering Cancer Center has published several articles regarding the high cost of new drugs, claiming that the manufacturers have total price control, which has led to irrational pricing behaviors. Dr Bach promotes a more rational, “value-based” approach, where the outcome determines the price.
Although we all admire and support the efforts put forth by many experts to help quantify the “real” value of cancer medications, they still miss the mark in 2 dramatic ways.
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 options will likely garner keen interest among providers participating in the OCM or similar programs, to the benefit of providers, payers, and patients.
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