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.1 According to ASCO, it is “an initial version of a conceptual framework for assessing the value of new cancer treatment options based on clinical benefit, side effects, and cost.”2 The intent is to provide a tool for oncologists to “use with their patients to discuss the relative value of new cancer therapies compared with established treatments.”2
Certainly, we are witnessing the introduction of new cancer therapies that are pushing drug costs to what many believe are unsustainable levels. Having a tool to be able to weigh costs with clinical benefits and side effects has value for oncologists. From that perspective, the value framework is a step in the right direction in terms of providing a conceptual basis for considering a new cancer treatment. It is understood that ASCO is “dipping its toes” into a very controversial area, but publishing the value framework as a journal article does not have a great deal of practical utility for oncologists. A tool such as the value framework will only become useful when it is incorporated into the oncologists’ workflow, which is becoming increasingly digital. That means not just a separate app but a tool built into the electronic medical record.
There are several concerns about the value framework. First, in an era when personalized medicine—the tailoring of treatment based on an individual’s genetics and other personalized characteristics—has so much promise in cancer care, the idea of a generalized tool that is “one-size-fits-all” seems to be a step backward. It is important that, even in its early stages, a tool such as the value framework is not used to preclude a treatment that is most effective for one individual versus another with the same cancer type.
Second, as much visibility as drug prices are getting in the press and from notable academics, drug cost is only one component of cancer care. Drug cost is typically 20% to 25% of the total cancer care cost, and even higher drug spending may reduce other cost components, such as expensive hospitalizations.
In addition, where the cancer care is administered significantly dictates costs, as evidenced by reports analyzing site-of-service cancer care costs for patients, for Medicare, and for private payers. One recent report from the US Government Accountability Office (GAO) documents the higher cost of cancer care when administered in one of the 11 major cancer hospitals,3 and another just-released GAO report analyzes the higher cost of cancer care when delivered in the 40% of hospitals with 340B drug discounts.4
If tools such as the value framework are going to be useful going forward, they must fit into the oncologist’s workflow, be in concert with the greater effectiveness and cost-efficiencies promised by personalized medicine, and fit into the totality of total cancer care costs, not just be focused on the drug price.
