The ASCO Value Framework: To What End?

July 2015, Vol 6, No 6

In the modern era of increasing healthcare costs, and with prescription drug expenditures forecasted to increase by 7% to 9% in the next year,1 a focused discussion on the value proposition of cancer care is warranted. The American Society of Clinical Oncology (ASCO) Value in Cancer Care Task Force should be commended for igniting the conversation about the value of chemotherapy regimens.2 We live in a society with a limited amount of resources, and, therefore, resources such as treatment options must be allocated appropriately to maximize the benefits to society.

According to the ASCO statement, the value framework is intended to be used by the clinician and the patient to facilitate a discussion and shared decision-making regarding the benefits of a treatment option within the context of cost.2 Although this is certainly a noble effort, one must wonder whether these individual-based discussions will effectively bend the cost curve. Harold C. Sox, MD, opined that such individually based interventions are “obsolete,” and that moving toward a population-based approach would be better for allocating scarce resources.3 However, if the goal of the ASCO value framework is to manage resources on a population-based level (as they suggest),2 then there are many other validated metrics available that are used in other countries, such as quality-adjusted life-year4 and incremental cost-effectiveness ratio.5

Finally, the ASCO value framework only considers the cost dimension on 2 domains—acquisition and patient out-of-pocket costs. Measuring the cost of a specific treatment option is not as straightforward and should consider other parameters, such as hospitalization, the use of supportive care measures, or laboratory monitoring. Indeed, difficulty with actualizing the monetary costs with various treatment regimens was the primary reason that my colleague and I did not include this variable in our preliminary tool that was developed for comparing the relative efficacy and toxicity of chemotherapy regimens.6

Given these concerns, one must ask of the ASCO value framework—To what end? With the current focus on population-based efforts (eg, accountable care organizations, oncology clinical pathways) and the availability of “gold-standard” metrics for healthcare resource allocation, it remains to be seen how this tool, which focuses on individual care, will be utilized by stakeholders.




References

  1. Schumock GT, Li EC, Suda KJ, et al. National trends in prescription drug expenditures and projections for 2015. Am J Health Syst Pharm. 2015;72:717-736. Erratum in: Am J Health Syst Pharm. 2015;72:771.
  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.
  3. Sox HC. Resolving the tension between population health and individual health care. JAMA. 2013;310:­1933-1934.
  4. Weinstein MC, Torrance G, McGuire A. QALYs: the basics. Value Health. 2009;12(suppl 1):S5-S9. Erratum in: Value Health. 2010;13:1065.
  5. Ioannidis JPA, Garber AM. Individualized cost-effectiveness analysis. PLoS Med. 2011;8:e1001058.
  6. Li EC, DeMartino J. Preliminary report: the development of the NCCN Comparative Therapeutic Index as a clinical evaluative process for existing data in oncology. J Natl Compr Canc Netw. 2010;8(suppl 5):S1-S9.

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