Value-Based Care

It is next to impossible for a day to go by without thinking about the contributions of personalized medicine to the care of patients living with cancer. Whether we are treating a newly diagnosed patient with HER2/neupositive breast cancer using trastuzumab, or using erlotinib in the management of a patient with non–small-cell lung cancer (NSCLC) whose tumor harbors specific mutations in the epidermal growth factor receptor genes, individualizing therapy based on molecular biology and genetic testing has become commonplace in contemporary oncology practice.

Philadelphia, PA—The “one-size-fitsall” approach to current benefit designs does not recognize that health services have different levels of value; such an approach, therefore, lacks incentives for patients to adhere to diagnostic tests and treatments with proven effectiveness that may help to contain costs to various healthcare stakeholders.

The focus on value in patient care has taken a prominent place in any discussion related to improving care delivery, but no agreement exists on what that “value” is.

Each year, oncologists return to their respective practices after attending the annual American Society of Clinical Oncology or American Society of Hematology meetings armed with knowledge of new drug/biologic combinations, modified regimen dosing, and other novel approaches that may provide incrementally better outcomes for cancer patients.

Prostate cancer patients have 2 new therapeutic options this summer with the approvals of sipuleucel-T and cabazitaxel. The former drug is an important scientific advance as one of the pioneering cancer vaccines to show a prolongation of survival.

Sipuleucel-T (Provenge) and cabazitaxel (Jevtana) have drawn much attention both for being the first new treatments for advanced prostate cancer since docetaxel (Taxotere) was approved in 2004, and for their high costs. As described in Dr Newcomer’s accompanying piece, they will add significantly to the cost of care for prostate cancer patients.

Several sessions at the recent ASCO meeting considered new standards for community-based oncology research and the development of comparative effectiveness research (CER) methods.

The Patient Protection and Affordable Care Act (PPACA), which is Congress’ latest attempt to reform our healthcare system, creates 3 new entities that will test new payment methodologies or compare current treatments in an attempt to determine better value for our healthcare dollar.

Recent articles in the New England Journal of Medicine¹ and the Journal of the American Medical Association² note the tremendous increase in the cost of cancer care, which has at least doubled since 1990. The reasons for this steep increase have been attributed to the release and utilization of new medications, in tandem with more sophisticated surgery and radiation techniques.