VBCC Perspectives

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.
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Several sessions at the recent ASCO meeting considered new standards for community-based oncology research and the development of comparative effectiveness research (CER) methods.
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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.
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Even before enactment of national healthcare reform initiatives, development and implementation of a variety of comparative effectiveness research (CER) was well under way, even if it was not specifically called comparative effectiveness.
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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.
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At the most basic level, compendia are drug information resources intended to aid clinicians in making “informed treatment decisions, especially in difficult and complex cases.”1 They were not intended for use in determining reimbursement of medications for the public and private healthcare insurance sectors. Nevertheless, this responsibility was assigned by the Centers for Medicare & Medicaid Services (CMS) in a 1993 law that requires Medicare plans to use 1 of 4 national compendia to determine coverage and pay for “off-label uses of anticancer drugs for Medicare beneficiaries.”
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As payers focus on the rising cancer care spend, they are turning to tools previously applied to other diseases. Each seems to have potential, but upon closer review, these have fundamental shortcomings when used for cancer.
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The 2007 annual meeting summary of the Institute of Medicine (IOM) succinctly highlighted the issue of variability in care.
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