Value-Based Tools Should Complement Clinicians’ Perspectives to Inform Best Treatment Decisions for the Individual Patient

Amy Grogg, PharmD

July 2015, Vol 6, No 6 - VBCC Perspectives


The American Society of Clinical Oncology (ASCO) value framework and Memorial Sloan Kettering Cancer Center (MSKCC)’s DrugAbacus are 2 recent examples of an increasing trend of value-­based modeling to assess pharmaceuticals. Of particular interest, these methodologies represent some of the first efforts to incorporate a systematic approach to value specific to oncology. Xcenda, an AmerisourceBergen company, has previously reported on the increasing shift to value-based care with the Department of Health & Human Services and select large US payers.1 Outside of the United States, single-payer systems in Europe have taken an even more aggressive approach to value-based models, going as far as to quantify the value of human life, and then to measure the use of a drug versus its ability to prolong life in a demonstrable way.

At a population level, formal and transparent systems to measure the value of new and existing treatments can be beneficial. That methodology has the potential to demonstrate how expensive treatments with significant results for patients provide more value than treatments that are less costly in the short-term. And with transparency, stakeholders can increasingly look to evaluate, design, and commercialize treatments with a set of consistent standards in mind. When this is done well, the entire healthcare system will be better informed on how to get the right drug to the right patient at the right time.

However, the trend toward value-based modeling should not supplant the autonomy of a clinician and a patient to make care decisions that take into account individual circumstances and scenarios that rigid guidelines could never predict or accommodate. Instead, tools such as ASCO’s value framework and MSKCC’s DrugAbacus should be used to inform payers, clinicians, and patients so they can make the most appropriate choices to drive the best possible outcomes for the particular patient.

These conversations should not only discuss the value of a treatment relative to its cost but also that patient’s individual goals, and the ability of a treatment to help achieve them. Treatment decisions should also incorporate the tools and resources that a patient will need to access and adhere to treatments, and to mitigate potential side effects that can increase the total cost of care. Ultimately, no matter what result is predicted via value-based modeling, it will only be achieved if patients are able to stay adherent to a treatment program.

In this paradigm, value-based models will enable patients and their care team, including clinicians and payers, to have informed, rational, and meaningful conversation about the cost of treatments and the potential benefits they will derive from them. When a treatment program is selected, it is the responsibility of all stakeholders to maximize its value by supporting appropriate access and adherence through a network of clinical and supportive care resources.




Reference

  1. Xcenda AmerisourceBergen. HHS, commercial payers outline plans to accelerate shift to value-based payments. Health Policy Wkly. January 30, 2015. www.xcenda.com/Insights-Library/Archive/HHS-Commercial-Payers-Outline-Plans-to-Accelerate-Shift-to-Value-Based-Payments/.