Assessing and Improving Value in Cancer Care Workshop Summary (2009) / Chapter Skim
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6 Value in Oncology Practice: Oncologist and Health Insurer Perspectives
6 Value in Oncology Practice: Oncologist and Health Insurer Perspectives
Pages 55-68
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From page 55... ...
, published a study of 90 oncologists from two leading academic medical centers who responded to a series of survey prompts regarding their views on costs and cost-effectiveness in cancer treatment. The study found that 77.5 percent of oncologists studied agreed that every patient should have access to effective cancer treatments regardless of their costs.
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From page 56... ...
Even though most surveyed oncologists agreed that costs should not affect care decisions, a majority required a minimum 2–4 months added survival to warrant the $70,000 expense. But there were a few at the extremes, such as one oncologist who would prescribe the medication for just one day of added survival.
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From page 57... ...
Dr. Neumann explained that he and his colleagues are completing a f ollow-up study to determine the extent to which oncologists nationwide believe that costs influence their prescribing behavior, whether they discuss costs with patients, and how they feel about various reimbursement policies.
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From page 58... ...
Health insurers, or payors, look at value very differently than one would for FDA studies or phase III randomized controlled trials (RCTs) , as these trials' results are limited to a very tightly defined group of patients in controlled treatments.
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From page 59... ...
Clearly, there is a great deal of inconsistency in adult oncology that hampers assessment of its value. 28.0 NYU Medical Center 27.1 24.0 Mount Sinai Hospital 22.8 New York Presbyterian Hospitals 21.6 Cedars-Sinai Medical Center 21.3 20.0 Days 16.0 UCLA Medical Center 16.1 12.0 UCSF Medical Center 11.5 Stanford University Hospital 10.1 8.0 FIGURE 6-2 Days in hospital during the last 6 months of life.
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From page 60... ...
Newcomer said, the United States needs its own National redrawn Institute for Health and Clinical Excellence editable Eventually, a certain vector, fully (NICE)
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From page 61... ...
, and it receives funding from the government. Most physicians do not believe it is independent of the government, and NICE is widely seen as a rationing body because of its health technology appraisal program, though it has programs in other areas such as public health interventions,
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From page 62... ...
. SOURCES: Drummond presentation, February 9, 2009; Jonsson and Wilking, 2007; based on IMS Health, IMS MIDAS Quantum (for South Africa, sales per capita is R01506 presented along with two capita rates for the total population as well as for the insured [18.5%]
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From page 63... ...
Data were extracted from published NICE technology appraisals and eventual licensure in the United Kingdom NICE drug appraisal outcomes were classified for each indication at one of three levels: (1) no restrictions for use in the NHS per the drug's license, (2)
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From page 64... ...
Regarding whether cancer drugs should be exempt from NICE rules, there has been a major development. Treatments can now qualify for what is called "supplementary guidance for end-of-life therapies" only if they are indicated for a small patient population with a life expectancy less than 24 months, if no equivalent active therapy exists, and if they would add at least three months to patients' life expectancy.
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From page 65... ...
Dr. Newcomer explained that the insurance regulations in the United States vary from state to state, and this introduces many barriers to implementing uniform coverage decisions.
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From page 66... ...
Dr. Newcomer recalled an article in Health Affairs that suggested oncologists were not prescribing just to make money when there was not a reasonable indication, though they were maximizing revenue by choosing the more expensive regimen when they had multiple options (Jacobson et al., 2006)
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From page 67... ...
1975. Information on 1976 health insurance premium rate increases for federal employees health benefits program.
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