The Alliance for Patient Access / IfPA’s Patient Access Policy Blog / NCCN Value Tool Overlooks Key Access Factors

NCCN Value Tool Overlooks Key Access Factors

by Amanda Conschafter, blog editor

The National Comprehensive Cancer Network has become the latest organization to offer a tool for evaluating cancer treatments based on price and effectiveness. This month, the nonprofit alliance of 26 cancer centers issued the first in a series of Evidence Blocks. The blocks score blood cancer therapies on a scale of one to five, evaluating efficacy, safety, quality, consistency of evidence, and affordability. But the approach overlooks a key factor—whether out-of-pocket costs allows for patients to access these medications in the first place.

In calculating affordability, a NCCN panel considered overall costs of the treatment regimen, including:

  • The cost of administering the medication
  • The price of related therapies such as anti-nausea medication and
  • The expense of managing the medication’s toxicities.

This is the first time NCCN has incorporated affordability into its assessment of treatment options. Yet the assessment overlooks certain key factors.

  1. The affordability calculation focuses solely on therapies’ costs, with no consideration of how these therapies impact overall health care spending. As Dr. Robert Goldberg pointed out in a blog post on the topic, even high-cost cancer medications can reduce costs elsewhere, particularly on hospitalizations. “In 1996 drugs were 3.7 percent of cancer spending and 62.4 percent went to hospitalization,” Dr. Goldberg explains. “By 2012, drug spending was 9.3 percent of cancer costs while the share going to hospitalization dropped to 41.3 percent.”
  1. The Evidence Blocks overlook the medications’ cost-sharing burden for patients. NCCN’s overall cost evaluation reflects total cost to the health care system. But health plans’ cost-sharing requirements can be the foremost – or only – affordability factor with direct implications for patients.

Overall price comparisons among medications can determine which drugs are costliest. But such data may be incidental to an actual cancer patient. If a medication, regardless of how it stacks up against other therapies, falls into a health plan’s specialty tier with a 30% or co-insurance payment requirement, it’s likely to be unaffordable, and inaccessible, to that patient. In such cases, evaluations of other factors such as efficacy and quality become obsolete.

WATCH: The Cost of Specialty Tiers

NCCN offers the Evidence Blocks as a supplement to its clinical practice guidelines and expects to issue Evidence Blocks for its NCCN Guidelines for Breast, Colon, Non-Small Cell Lung, and Rectal Cancers by the end of 2015.

For more on value assessment approaches, see “Will New Medicare Payment Model Hurt Individualized Cancer Care?” and “ASCO Value Framework Sparks Dialogue on Patient-centered Care.”

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The Alliance for Patient Access is a national network of physicians dedicated to ensuring patient access to approved therapies and appropriate clinical care.
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