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VBCC Perspectives

Given the number of oncology agents introduced over the past 5 years, and the corresponding rise in costs, it is little surprise that multiple organizations are reacting with methods to assess value. Although payers have historically been the default for assessing value to determine formulary coverage, the most recent entrants of the American Society of Clinical Oncology (ASCO), with its value framework, and Memorial Sloan Kettering Cancer Center (MSKCC), with its DrugAbacus, into this arena represent providers of oncology care. Historically pegged as solely focused on clinical evidence and seeking effective therapy at all costs, the focus by providers on the value of cancer care is increasing.
The relative value of cancer care has become the major debate in oncology over the past few years. The rising costs of treatment, along with increasing out-of-pocket costs for patients, have sparked a debate about what is “reasonable” treatment for all involved. As a nonprofit patient assistance foundation, Patient Services provides financial assistance to patients who have great challenges in accessing their treatments because of the high costs. Of note, most of those who receive assistance from our foundation are insured.
The high costs of specialty medications and the burden they place on individual patients and on the healthcare system overall are the media topics du jour. Cancer drugs are often cited as examples of unrestrained medication costs, so it is not surprising that the oncology community has responded by proposing alternative pricing models for cancer treatments based on the incremental value they provide.
Value versus cost is becoming an increasingly common question, particularly when evaluating new cancer drugs. The American Society of Clinical Oncology recently published its initial value framework to assist in assessing the value of new cancer therapies.
With all the focus in the media on cancer drug costs, let alone within the oncology community, the American Society of Clinical Oncology (ASCO) has released its much-anticipated value framework.
I grew up in a lower middle class household. My dad was an insurance salesman, and we needed to live within a budget. The thought that we might buy something without considering the cost was unfathomable. As a doctor now, I wonder how we expect our patients to make healthcare purchases without this information. Why do we need to even justify discussing cost with patients?
Pain is often thought of as the fifth vital sign; namely, pain is such a prevalent problem in patients with cancer, that we should strive to measure it at every visit and minimize it as part of patient-centered care. The job of the oncologist is to cure (when possible), prolong survival while maintaining quality of life (when possible), and to minimize pain and suffering, particularly for our patients who are not going to be cured of their malignancy.
Oncology payment reform is a hot topic in the provider and payer communities. Numerous models and pilots have been introduced to define the value of cancer care, improve the quality, and/or control costs. The transition to a system that values outcomes over the quantity of services is driving this reform. Cancer care has changed a lot and continues to change rapidly, but transparency regarding cost and outcomes and the understanding of value has lagged behind.
The Merriam-Webster dictionary defines “logistics” as the things that must be done to plan and organize a complicated activity that involves many people. The modern delivery of cancer care precisely parallels this definition.
Sandra Wade first e-mailed me on July 15, 2011. As you can see in the excerpts from her correspondence with me below, she asked me to contact her oncologist and let her know that as a breast cancer survivor, Sandra had suffered more than she should have, because she was not referred for rehabilitation services.
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