Institute for Patient Access paper explains value models must serve as tools, not replacements, for physician decision-making
WASHINGTON – The Institute for Patient Access released a new policy paper, “Oncology Value Models,” which offers a physician’s perspective on recent value models and explains why these models should not be misused as a tool for rationing care and limiting access.
What is good value in terms of cancer treatment? The question, amid rising cancer care costs, has prompted a surge of oncology value models in recent years. These models mean to link the price of care with a drug’s proven benefit.
Authored by oncologist Joanne Dragun, MD, and Mary Ann Chapman, PhD, the paper acknowledges a number of challenges. For instance, while policymakers and health plans may focus on quantifiable measures such as price and outcomes, patients may define value in terms of their own quality of life. Even models that do incorporate patient values may not encompass the precise values that matter to a given patient – or prioritize them in the same way that a patient does.
Yet price must be part of the care conversation, the authors concede. Doctors cannot present a patient with a care plan “in a vacuum” that ignores factors such as high out-of-pocket costs.
The paper briefly considers four of the most prominent value models created in recent years:
- American Society of Clinical Oncology Model,whose Net Health Benefit score incorporates treatment benefit, side effects, improvement in quality of life, and reduction in cancer-related symptoms.
- National Comprehensive Cancer Network Model,which uses 5 x 5 Evidence Blocks™ to rate treatments from 1 to 5 for five values: treatment efficacy, safety, quality of evidence, consistency of evidence, and affordability.
- Memorial Sloan Kettering Cancer Center Model,whose online Drug Abacus estimates what cancer medications should cost based on the emphasis a user places on values such as: price per year of life, severe side effects, and factors related to drug development and cancer population.
- Institute for Clinical and Economic Review Model, which generates a benchmark price for therapies based on long-term monetary value and short-term affordability, focusing on the population perspective.
Although oncology value models can be useful, health plans may use data from these models to restrict access to medications prescribed by patient’s doctors, undermining physicians’ ability to make patient-specific decisions. Or cancer care centers may pressure physicians to recommend medications based on how they fare in a given oncology value model.
To keep cancer care personalized, effective and rooted in the physician-patient relationship, the paper concludes, these models cannot be misused as tool for rationing care and limiting access.