Who Defines Value?

Art Wood

July 2015, Vol 6, No 6 - VBCC Perspectives

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.

There is a new catchword being utilized today, pointing to those who are “underinsured.” Just because a patient is insured does not guarantee that he or she will be able to afford the treatment. Our company has seen over recent years that more and more cost is being shifted to patients as a result of a number of factors.

A joint study from USA Today, the Kaiser Family Foundation, and the Harvard School of Public Health showed that approximately 33% of patients have either used up all or most of their savings because of the high costs of their cancer drugs or had a problem affording basic necessities (eg, food, heat, or housing) as a result of their cancer.1 Some of the recent treatments in oncology have provided a revolutionary benefit to patients, but they have come with an extremely high cost. These treatments for patients with whom we work may be thousands of dollars monthly. For patients with middle-class incomes (or even for some with generous incomes), these costs are impossible to absorb. Payers are seeking to minimize their liability in absorbing the high costs of these drugs by increasing cost-sharing for patients (who are the most vulnerable).

The key question is—how does one define value? Is it efficacy of treatment? Is it minimal side effects? Is it increased life span? Is it quality of life? Is it simply cost-effectiveness? This is a complicated question. The American Society of Clinical Oncology has developed a new framework statement on the cost of cancer care, which provides some guidelines to facilitate a discussion by all parties involved.2

A better understanding of these issues will be important to have better access to treatment; however, it is important to keep in mind that no matter how good the treatment is, it is useless to patients if they cannot afford to access it.


  1. Kaiser Family Foundation, Harvard School of Public Health. The USA Today/Kaiser Family Foundation/Harvard School of Public Health National Survey of Households Affected by Cancer. November 2006. https://kaiserfamilyfoundation.files.wordpress.com/2013/01/7590.pdf. Accessed July 8, 2015.
  2. Schnipper LE, Davidson NE, Wollins DS, et al. American Society of Clinical Oncology statement: a conceptual framework to assess the value of cancer treatment options. J Clin Oncol. 2015 Jun 22. Epub ahead of print.