On June 22, 2105, the American Society of Clinical Oncology published the ACSO Value Framework – “a conceptual framework for assessing the value of new cancer therapies based on treatment benefits, toxicities, and costs”. The framework received a fair amount of publicity, including “Cancer Doctors Offer Way to Compare Medicines, Including by Cost” by Andrew Pollack of the New York Times. ASCO is solicited comments from all interested stakeholders through August 21, 2015 and I encourage you to reach out to the corresponding author of the survey Lowell E. Schnipper, MD. Here’s why.
Now is the time to help shape the standards for value-based case and augment the effort with what’s strikingly missing from this discussion – the role of technology, specifically data-driven analytics and insights, in bridging the knowledge gap around value. Leveraging these technologies would enable manufacturers, payors, physicians, and patients to be in a position to have discussions and truly make joint decisions to impact patient care while bending the cost conundrum. Only then would pharmaceutical and biotech companies have the pivotal vantage point across the full drug cycle; and payers – the complete means to compare one treatment options to another.
The cost/benefit discussion is the right discussion, and the time is now to start leading with value and bring cost in as part of the value-based discussion, ASCO’s efforts, especially their emphasis on physician advocacy for the patient and the increased need for transparency, highlights some aspects of the proposed framework that will remain conceptual unless it considers and encourages the transformational power of technology in bringing together the needed evidence to align value to all stakeholders, with the patient at its epicenter:
- ASCO’s proposed framework links increasing healthcare costs to “the adoption of newer, more expensive diagnostic and therapeutic interventions may not be well supported by medical evidence, thereby raising costs without improving outcomes”. The medical evidence is now available – not only from clinical trials, but from real-world data sets in EMRs, claims and pharmacy databases across the country. All healthcare stakeholders have the comprehensive evidence and insights (today!) to make the right decisions for each and every patient, every time. When the industry aligns along the patient and the value that specific therapeutics bring to her, we will also reduce the incidence of financial toxicity, which as described by ASCO, is the vernacular describing “the financial distress that now often accompanies cancer treatment”.
- We cannot put the burden of value definition on the physician. Value can be defined today better and more completely than ever before with the assistance of technology. Policymakers and payers can jointly seek ways to assure the best use of limited resources by not only “turning to physician experts for a better understanding—and definition—of value”, but by enabling physicians with the evidence to improve outcomes and, in the process, drive costs down. And only then, equipped with all the data, can a physician become the patient’s best advocate and resource for “guidance in assessing the value of treatment options”.
- Oncologists should have the benefit of making informed decisions regarding the value of care, “understanding both the most accurate and up-to-date information on benefits and costs to patients and society”. Yes, value must be assessed using only the highest-quality evidence available. And no, such evidence should not be derived from prospective randomized trials published in peer-reviewed journals only.
- There is no doubt that “to ensure informed decision making, patients need access to both clinical and cost information about their treatment options”. We know that not all cancer patients are alike. The promise of individualized and personalized healthcare is not only possible – indeed, it is much needed today. Patients should be in a position to evaluate the possible clinical benefits and harms of treatment options available to them, based on similar patient journeys, not limited clinical trial data. The access to this information should not be a privilege, it should be a patient right.
Historically, large retail markets for blockbuster drugs and volume- based treatment regimens contributed the vast majority of data-related decisions across healthcare. This is no longer the case. Today, by integrating clinical and claims information, payers, patients, physicians and manufacturers all can and should have direct line of sight into the comparative effectiveness of ALL value measurements across ALL therapeutic areas. At the end of the day, the outcome or result of a treatment should drive its value in the market relative to other options. When all stakeholders have access to integrated insights, they all will benefit:
- Manufacturers will make better business decisions on moving molecules and therapies through clinical trials, forecasting against depth and breadth of patient populations, along with use of resources for contracting, selling and marketing a product.
- Payers will compare therapies against one another using longitudinal outcomes data for contracting with manufacturers. They will be able to identify predictable patient populations to be targeted for certain drugs.
- Providers will benefit by comparing patient populations to their own patients. They will be able to choose the right therapeutic rooted in real- world outcomes data as opposed just clinical trial and marketing data.
- Patients will then become the center and main beneficiary of this entire paradigm.
We live in transformational times – and it is up to us to decide if we will watch from the sidelines or step up to support and augment the earnest efforts of ASCO to bring value at the forefront of the discussion and patient care. Contact corresponding author Lowell E. Schnipper, MD, to get involved in the discussion here. We also welcome your comments at firstname.lastname@example.org.
Brian Irwin, Vice President of Strategy