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    The Future of Oncology Treatment Is Value Assessment

    How value assessment tools enhance decision-making in oncology.

    Value assessments are a new and evolving area, and have the potential to make a tremendous impact on patient treatment decisions, as well as on coverage and reimbursement decisions, according to a statement from the National Pharmaceutical Council (NPC).

    In recent years, according to the information from NPC, a number of organizations have developed frameworks to assess new treatments (Fig. 1). 

    Fig. 1Fig. 1“Value assessment may become more important as the health-care market shifts to outcomes and value-based reimbursement models,” said Jeremy Schafer, PharmD, MBA, Senior Vice President and Director for Payer Access Solutions at Precision for Value. It’s important for the oncology pharmacist to be familiar with each of the existing tools, including the methods through which value frameworks reach their conclusions and the way in which each framework is intended to be used, he added.

    “We have done a significant amount of market research in this area and found that the majority of payers are at least familiar with value frameworks and many are using them”, said Schafer. The National Comprehensive Cancer Network’s (NCCN) Evidence Blocks tend to be the most popular frameworks, he said, since payers already rely on NCCN for oncology coverage decisions. “Our research has also found that payers currently not using value frameworks either anticipate doing so in the future or are relying on internal cost-effective analyses within their organizations,” he said.

    “The most common way payers are using value frameworks is in choosing preferred therapies, comparing products within a class, and policy/pathway development,” Schafer told Drug Topics. Since head-to-head trials are generally lacking among similar agents in oncology, the value frameworks provide payers with a way to make these comparisons, although not necessarily in the most scientific rigorous way.

    “Many of the methodologies and thresholds used in the frameworks have not been tested or vetted, which not only causes uncertainty about the validity of the results but creates uncertainty about whether the frameworks are useful for their intended purpose. The evidence base for many of the frameworks is quite limited,” said NPC in its statement. 

    Related article: Business Group Makes Price Recommendations for Specialty Drugs

    It’s critical for pharmacists to be involved in the creation of value frameworks,” said Rowena Schwartz, PharmD, BCOP, Associate Professor of Pharmacy Practice at the University of Cincinnati in Cincinnati. “Pharmacists with the right skill sets, such as a knowledge of clinical practice and economics, need to be included,” she said.

    In developing value frameworks NPC feels that all aspects of care should be considered, not just drugs. Additionally, all relevant stakeholders should be included, and economic models should be readily available, it stated. Transparency should be maintained at every step.

    Existing frameworks incorporate safety and efficacy data from clinical trials into the valuation process, said Schafer. However, the current models may be lacking in some areas that are important to patients and providers. For example, “quality of life changes may not be addressed by all frameworks and the benefit to society of extended life for individual patients may be missing, as well,” he said.

    Up next: Problems and solutions

    Kathleen Gannon Longo
    Kathleen Gannon Longo is a Contributing Editor.

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