ASCO 2015 Highlights

Chicago, IL—At the special session on value during the 2015 American Society of Clinical Oncology meeting, Jennifer Malin, MD, PhD, Staff Vice President for Clinical Strategy, Anthem, Thousand Oaks, CA, presented the payer perspective on value in cancer care. The role of the payer, Dr Malin said, is to balance different stakeholders’ values and needs at various time points.

Chicago, IL—The presidential keynote address at the 2015 American Society of Clinical Oncology meeting was presented by Michael E. Porter, PhD, MBA, Bishop William Lawrence University Professor, Harvard Business School, Boston, who started the value discussions a decade ago. A strong proponent of changing the healthcare system to focus on value, Dr Porter suggests that the fundamental purpose of healthcare is to deliver great outcomes with increasing efficiency, but achieving this goal requires more holistic thinking about delivery care as science.

With all the focus in the media on cancer drug costs, let alone within the oncology community, the American Society of Clinical Oncology (ASCO) has released its much-anticipated value framework.

Value versus cost is becoming an increasingly common question, particularly when evaluating new cancer drugs. The American Society of Clinical Oncology recently published its initial value framework to assist in assessing the value of new cancer therapies.

The high costs of specialty medications and the burden they place on individual patients and on the healthcare system overall are the media topics du jour. Cancer drugs are often cited as examples of unrestrained medication costs, so it is not surprising that the oncology community has responded by proposing alternative pricing models for cancer treatments based on the incremental value they provide.

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.

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.

Given the number of oncology agents introduced over the past 5 years, and the corresponding rise in costs, it is little surprise that multiple organizations are reacting with methods to assess value. Although payers have historically been the default for assessing value to determine formulary coverage, the most recent entrants of the American Society of Clinical Oncology (ASCO), with its value framework, and Memorial Sloan Kettering Cancer Center (MSKCC), with its DrugAbacus, into this arena represent providers of oncology care. Historically pegged as solely focused on clinical evidence and seeking effective therapy at all costs, the focus by providers on the value of cancer care is increasing.

In 2012 and 2013, the American Society of Clinical Oncology (ASCO) published 2 sets of 5 key opportunities to improve value in cancer care as part of a multispecialty project, called Choosing Wisely. As a supervisor for a process that reviewed more than 15,000 hematology and oncology treatment requests in 2013, we were able to observe oncologists who followed ASCO’s advice, and those who were either unaware of Choosing Wisely or who chose to disregard it. Although the recommendations were not universally followed, they were a tremendous step forward in advancing value-based oncology treatments.