Assessing and Improving Value in Cancer Care Workshop Summary (2009) / Chapter Skim
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9 Toward a Shared Understanding of Value
9 Toward a Shared Understanding of Value
Pages 109-116
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From page 109... ...
Second, Dr. Bach extended an invitation to all the workshop attendees to synthesize what they had learned over the course of the workshop by raising key remaining questions, suggesting next steps, or proposing solutions for assessing and improving value in cancer care.
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From page 110... ...
Alternatively, a reimbursement-structured model, Dr. Bach said, would establish clinically-based drug interchangeability criteria to increase direct competition between drugs and manufacturers, interrupt the monopoly pricing structures manufacturers now benefit from, and drive down prices.
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From page 111... ...
The ASCO Cost of Care Task Force has been working for a year; learning modules to improve physician communication skills are being developed, and informational materials have been made available to help physicians and patients engage in difficult conversations about costs of care. The Quality Oncology Practice Initiative has the ability to measure many of the outcomes relevant to cancer care value through the 400 practices it tracks, and this data could be used to benchmark best practices and drive improvement in oncologists' performance on a large scale through self-correction among academics and the community oncologists alike.
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From page 112... ...
Lerner's panel, he said, discussed the poor incentive structures in oncology, the numerous constituencies to be taken into account when pharmaceutical manufacturers price a drug, and the barriers to generating meaningful cost-effectiveness data in clinical trials. Reflecting on the workshop as a whole, Dr.
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From page 113... ...
The U.S. health care system has often been called a "blank check" health care system in that those of us who have excellent private health insurance are able to receive any care for which we expect a marginal positive health benefit, regardless of the societal marginal cost, Dr.
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From page 114... ...
Ganz concluded that the price that pharmaceutical manufacturers choose at the launch of a drug may not be the appropriate price once it has been studied in a larger population or earlier in the course of disease. While drug prices at launch may be too high for their survival benefit, if the drug is very valuable when studied in larger populations, pharmaceutical manufacturers should not be penalized and forced to set artificially low initial prices.
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From page 115... ...
Smith. Another participant suggested adding the public at large or a societal perspective to the list of stakeholder perspectives, as well as adverse events associated with treatment to the value attributes.
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From page 116... ...
TABLE 9-1 Proposed Value Attributes, Value Metrics, and Stakeholder Perspectives 116 Attributes of Value Metrics of Value Pertinent Stakeholder Perspectives Outcome Attributes Economic Metrics Patient perspective, including families or other Survival -- duration of life Cost per QALY social supports Quality of life Equity Metrics Physician or clinician perspective Adverse events Variation in care Health insurer perspective -- public and private Time to progression Financial hardship Pharmaceutical manufacturer perspective Tumor response Workforce or service shortages Societal perspective -- the public at large Cost Access to insurance and appropriate services Care Attributes Disparities in care Access to care Innovation Metrics Quality of care Willingness to pay for cancer treatment research Communication FDA new drug applications Social equity Generic treatments Patient-Centered Attributes Biosimilars Compassion and respect Care Metrics Opportunity for treatment benefit Quality of clinician–patient communication Choice Coordination of care Hope Innovation and Future Discovery SOURCE: Ramsey presentation, February 10, 2009.
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