Oncologists Must Begin to Address Value in Patient Care

Dana Butler

September 2014, Vol 5, No 7 - Value in Oncology

Chicago, IL—The topic of value in cancer care was addressed at a special session at the 2014 American Society of Clinical Oncology (ASCO) meeting. Lowell E. Schnipper, MD, Harvard Medical School, Boston, and Chair of the ASCO Task Force on Value in Cancer Care noted that value is not about the number of dollars spent but rather about the cost of a treatment to a patient, who may experience financial and physical toxicities.

“We need to begin a conversation about what is the value for the patient—not the dollars expended, but how well we are doing for our patients. What is their physical and financial toxicity?” Dr Schnipper emphasized.

Value Affected by Many Aspects of Care
Dr Schnipper noted that the concept of value is centered around the patient, and the success of a value-based treatment is determined by the out comes, not by the volume of care.

Patient-centered care is the key element in value-based care, and this is true in oncology as in other disciplines. Oncologists should “use all health-related resources in an appropriate manner that is resource-efficient. This implies doing our best for our patients,” he said.

The elements that comprise value in patient care include variation in quality and outcomes, harm to the patient, waste, health disparities, and the failure to prevent disease. The Quality Oncology Practice Initiative should help to minimize variation in the quality of care. New models of payment reform are currently being tested by providers and payers to improve value-based care.

Oncologists Wrestling with a Value System
The goal is to create a transparent, clinically driven, methodologically sound method for defining and assessing the relative value of care options in oncology, which ultimately would “drive change” among payers and industry and would encourage the promotion of high-value care, Dr Schnipper said.

“We want to give oncology providers the skills and tools to assess the relative value of therapies and use these in discussing treatment options with patients,” he said. “And we want patients to have ready access to information that will help them understand the relative value of treatment options that meet their unique needs.”

The tool would describe the different clinical scenarios, treatments, benefits, toxicities, and costs related to cancer care and ascribe each treatment as having no value, low value, medium value, or high value. In patients with non–small-cell lung cancer (NSCLC), for example, the value parameters will include treatment regimen, median overall survival (OS), hazard ratio, progression-free survival, palliative data, time to next treatment, toxicity, and the total cost of care.

For example, for the first-line treatment of NSCLC, carboplatin (Paraplatin) plus paclitaxel (Taxol) yields a median OS of 8.2 months and costs $374; cisplatin (Platinol) plus pemetrexed (Alimta) offers 10.3-month survival and costs $6183; the combination of paclitaxel, carboplatin, and bevacizumab (Avastin) results in a 12.3-month survival and costs $8329.

“We are wrestling with data like these to provide a value system that would provide some degree of nuance and distinguishability among regimens,” Dr Schnipper said.

The value algorithm will also consider the different toxicity profiles and the treatment setting, because similar degrees of drug-induced toxicity will be viewed differently in early disease and in metastatic disease.

“Ultimately, we hope to finalize a way of quantifying with a numerical score, which ideally would summate to 100,” he said, and would be proportionate to the degree of benefit. The test will be whether this approach takes hold and develops traction, Dr Schnipper noted.