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November 2015An Update on the ASCO Value Framework
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Early results are in on the groundbreaking initiative by the American Society of Clinical Oncology (ASCO) to create a conceptual framework for calculating the value of cancer treatment options.
The tool was announced in late June and published in the Journal of Clinical Oncology (published online ahead of print June 22, 2015). The paper describes how the proposed calculation tool could be used in clinical practice. Providers would use the tool to give patients a detailed accounting of the expected out-of-pocket and drug acquisition costs associated with a given treatment under consideration, along with a net health benefit (NHB) score. NHB represents the added clinical benefit that patients can expect to receive from the treatment, when compared with the current standard of care. The framework tool is based in part on elements of care quality, efficiency, and cost set forth by the National Academy of Medicine.
“We’ve received more than 400 responses since the comment period for the framework ended on August 21,” said Lowell E. Schnipper, MD, FASCO, chair of the ASCO Value in Cancer Care Task Force, which spearheaded the project. “Although lots of commenters suggested we tweak certain elements of the formula, the vast majority congratulated us for tackling an incredibly thorny problem,” he said in an exclusive interview with ENTtoday.
Dr. Schnipper, who is the Theodore W. and Evelyn G. Berenson Professor in the department of medicine at Harvard Medical School and chief of hematology/oncology and clinical director at Beth Israel Deaconess Medical Center Cancer Center, both in Boston, offered more details on the type of feedback received.
Some commenters suggested that the ASCO framework tool should record length of survival in absolute terms or years, “because if you have a doubling of survival in an aggressive disease with a very short natural history, that could still leave the patient with a very short time from which they are benefitting, versus someone with a much longer course or time-frame,” Dr. Schnipper said. In such a case, “the absolute differences in time become much more important, and we need to account for that.”
Commenters also suggested tweaks to how the tool calculates toxicity, so that “we’re not just counting all toxic reactions equally,” he noted. “Rather, we should be taking points of score away from very disabling reactions, as opposed to penalizing for those that aren’t very troublesome.”