The Missing Elements in Our Value-Based Care Discussions

August 2015, Vol 6, No 7
Kevin Cast
Former Vice President, Global Pharma Business Development, Express Scripts

Although we all admire and support the efforts put forth by many experts to help quantify the “real” value of cancer medications, they still miss the mark in 2 dramatic ways:

1. Is it really reasonable to expect a person with newly diagnosed disease (and his or her spouse or caregiver) to understand the complexities of a net health benefit score,1 or of the DrugAbacus?2

I recently went through this experience with my father-in-law as he was diagnosed (and recently passed away) with mesothelioma. No number could have made the decision to undergo chemotherapy any simpler.

2. We all understand and even acknowledge that the cost of medication is only a portion of the total cost to treat cancer, yet none of the recently discussed/developed tools factor the cost of hospitalizations, healthcare providers, laboratory tests, magnetic resonance imaging, and so on, into the equation. We continue to focus on a small portion of the total cost of treatment, rather than the entire picture.

As pharmaceutical companies develop more targeted and efficacious medications, we will expect the price of the drugs to escalate, but this can only be affordable if the other associated costs, in turn, diminish. The US healthcare system needs to work together and become aligned regarding the cost of care.


  1. 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.
  2. Loftus P. How much should cancer drugs cost? Memorial Sloan Kettering doctors create pricing calculator that weighs factors such as side effects, extra years of life. Wall Street Journal. June 18, 2015.

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