ASCO Publishes Conceptual Framework to Assess the Value of New Cancer Treatment Options
In a press conference today, ASCO detailed the contents of the initial version of a conceptual framework for assessing the value of new cancer treatment options based on the treatment’s clinical benefit, side effects, and cost. Other important measures, such as quality of life and patient-reported outcomes, were not included in the initial framework because they are not reported consistently enough to be reliable. The framework was published by Schnipper et al in the Journal of Clinical Oncology.
The goal of ASCO’s Value Framework, which was developed with input from patient advocates, oncologists, and representatives from the pharmaceutical and insurance industries, is to become a tool physicians and patients can use to make better-informed, shared decisions about the benefits and costs of new cancer treatment options and help stem the rising costs of cancer care, projected to increase from $125 billion in 2010 to $158 billion in 2020.
Defining ‘Value’
The ASCO Value Framework is the result of the work of ASCO’s Value in Cancer Care Task Force, which was charged with identifying the drivers of the increasing costs of oncology care and developing policy positions to ensure greater access to high-quality care, educating oncologists about the importance of discussing the cost of recommended treatments, and empowering patients to ask questions about he potential costs of their treatment options. Based on the Task Force’s findings, ASCO chose to define value in cancer care by emphasizing three critical elements: clinical benefit, toxicity, and cost.
“As a physician, I’m really excited about this framework and I think it will help respond to a very clear and urgent need for cancer patients as well as the providers caring for them,” said ASCO President Julie M. Vose, MD, MBA, FASCO, Chief of Oncology/Hematology at the University of Nebraska Medical Center and Associate Director of Clinical Research at the Fred and Pamela Buffett Cancer Center in Omaha, during the press conference. “Value and cost are some of the biggest issues in health care today, and cancer care costs have been a particular focus of discussion and debate.”
ASCO Value Framework Overview
- Two versions of the framework have been developed: one for advanced cancer and another for potentially curative treatment. Data on both the clinical benefits and side effects of each therapy regimen are used to calculate a combined Net Health Benefit (NHB) score, which represents the added benefit that patients can be expected to receive from the new therapy vs the current standard of care.
- The NHB is calculated based on improvement in overall or progression-free survival and on the number and severity of treatment toxicities. For patients with metastatic cancer, a higher NHB is given for regimens that also offer relief from cancer-related symptoms or allow patients a treatment-free period.
- The NHB is presented alongside the patient’s expected out-of-pocket costs for the regimens being compared, as well as the overall drug acquisition cost.
- The framework is designed for physicians to use on an individual basis with their patients and does not provide generalizable scores or rankings.
- Once the framework is finalized and adapted into a practical tool for clinical use, doctors will be able to adjust parameters based on an individual patient’s health needs, preferences, and financial situation, which will result in a personalized value assessment.
“This [value framework] is not meant to be a ranking or a calculator for individual drugs. It’s a way to provide information in a standardized and objective way to both physicians and patients about the value of new treatment options that emerge from clinical trials comparing a standard of care to a new treatment option,” said Lowell E. Schnipper, MD, Co-Chair of ASCO’s Value in Cancer Care Task Force, Theodore W. and Evelyn G. Berenson Professor in the Department of Medicine at Harvard Medical School, and Clinical Director of the Cancer Center and Chief of Hematology/Oncology at Beth Israel Deaconess Medical Center in Boston, during the press conference.
Next Steps
The period for public commentary on the framework will close on August 21, 2015. To submit feedback, go to asco.org/value. Once ASCO receives commentary from all stakeholders and the details of the framework are finalized, the Society plans to convert the information into a software program that will calculate a regimen’s clinical benefit, toxicity, and cost.
“[The framework] is a tool and by no means a substitute for the physician’s judgment or for patient preference,” said Dr. Schnipper. “This framework is hoped to facilitate conversations in which the options for patients’ preferences with respect to different possible therapies are explained, and it’s not about winnowing options but about broadening them.”
An interview with Dr. Schnipper about the ASCO Value Framework will appear in the June 25, 2015, issue of The ASCO Post.
Full disclosures of the study authors are available at jco.ascopubs.org.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
