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The rising price of cancer drugs in the US has drawn plenty of criticism, and can be particularly frustrating for physicians and patients given the lack of transparency about how much bang they are getting for their buck.
A taskforce of clinicians convened by the American Society of Clinical Oncology (ASCO) last week published the details of a "value framework" for scoring cancer drugs based on their benefit/risk profiles, which will be made available alongside each drugs price to allow physicians and patients to have a more open discussion about how to proceed with treatment. (See ViewPoints: ASCOs new tool for rating cancer drugs is a much-needed first step towards bending the cost curve.)
Specifically, the framework uses the results from clinical trials of a drug to assign it a "net health benefit" score based on the level of efficacy and side effects that were observed. Medicines offering more benefit and/or less toxicity receive higher scores than drugs with less benefit and/or more toxicity. The maximum score for drugs in the adjuvant setting is 100, while the scale used for those treating metastatic disease goes up to 130, including 30 "bonus" points for improving symptoms or quality of life.
Clifford Hudis, a medical oncologist at Memorial Sloan Kettering Cancer Center and a co-author of the paper describing the framework, told FirstWord PLUS that the taskforce hopes it will eventually evolve into an easy-to-use tool to compare the value of different drugs in specific tumour types. However, he also acknowledged that the initial framework will require plenty of refining, meaning last weeks version is intended to elicit feedback from stakeholders.
One notable aspect of the framework is what it does not do in that it stops short of combining the "net health benefit" and cost, which is a logical next step that organisations like the National Institute for Health and Care Excellence (NICE) in the UK have in fact taken and use to measure a drugs cost effectiveness, with those deemed not to be cost effective not being eligible for reimbursement.
To gain better understanding about physicians feelings on ASCOs newly released framework, FirstWord PLUS is polling US-based oncologists and asking them
- How often do you to take the cost of a cancer drug into consideration when making a recommendation on a patients course of treatment?
- This week, ASCO proposed a framework for assigning a cancer drug a score based on its risk/benefit profile, which clinicians can use along with the drugs price to help inform treatment decisions. The physicians who came up with it noted that it is a draft proposal that needs refining. How likely are you to use the limited information from the preliminary framework to help guide your discussions with cancer patients?
- How confident are you that ASCOs preliminary framework will eventually evolve into a standardised tool that can be used in the real world to help guide cancer treatment?
- What represents the biggest challenge in developing a standardised tool that can be used in the real world to help guide cancer treatment?
- ASCOs preliminary framework stops short of incorporating the cost of a drug into the final score it is assigned. Would you prefer that cost be included in the final score?
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