NEW YORK —
The American Society of Clinical Oncology's "value framework" is part of a change in thinking among doctors, who once largely chose drugs based on medical attributes alone. The major cardiology societies, for instance, are also starting to factor cost into their evaluations of drugs.
"The reality is that many patients don't get this information from their doctors, and many doctors don't have the information they need to talk with their patients about costs," Dr. Richard Schilsky, chief medical officer of the oncology society, said at a news conference Monday.
He said the price of new cancer drugs now averages $10,000 a month, and some cost $30,000 a month, which can mean prohibitive copayments even for patients with good insurance. "Many cancer patients are facing severe financial strain, even bankruptcy in some cases," he said.
The value framework envisions considering two costs: the out-of-pocket costs for the patient and the overall cost of a drug to the health system.
Evaluating the latter cost would put doctors in the role of being stewards of societal resources. That is somewhat of a controversial role for doctors because it might conflict with their duty to the patient in front of them. But the oncology society said it did not see those roles as being in conflict.
The framework, published online Monday by the Journal of Clinical Oncology, is more of a proposed methodology than a final evaluation of different drugs. The society said it would solicit comments from the public and then possibly revise it. Moreover, it will take time to input the data on the effectiveness, side effects, and costs of each drug, and convert it to a system that can be used on computers and mobile phones.
There is no requirement that doctors use the framework, and it remains to be seen whether they will. But the authors of the document say it is a start.
"It allows the patient and the doctor to at least talk through the issues," said Dr. Lee N. Newcomer, senior vice president for oncology at insurance company UnitedHealth and a member of the task force. "Before, the information wasn't there."
UnitedHealth is mounting a similar effort of its own, Newcomer said. Starting this month, it is requiring oncologists to get prior approval from the insurance company for every cancer drug they administer. The company will then track what happens to patients. Two years from now, when a doctor asks permission to use a certain drug, the company will provide information on how the results from that drug compared with the results of using other drugs.
Several of the physicians who contributed to the report are from medical institutions in Massachusetts, and Dr. Lowell E. Schnipper, the lead author listed on the study, is clinical director of the Beth Israel Deaconess Medical Center Cancer Center.
Concern about cancer drug prices has been rising for years, and there have been public signs of revolt. At its annual meeting late last month, the oncology society included a talk lambasting the prices of cancer drugs as part of its plenary session.
Some experts say that, ideally, the price of a drug should reflect its value, but that does not seem to be the case with cancer drugs. A recent study by researchers from the National Cancer Institute, published in JAMA Oncology, surveyed cancer drugs approved from 2009 through 2013. It found that prices did not correlate very well with how novel a drug was or whether it prolonged life, versus just shrinking tumors.
So there can be great differences in the value of different treatments. The framework is supposed to be a standardized tool for evaluating drugs. It computes a score — called the net health benefit — based on clinical trial data.
Drugs for advanced cancer are given a score from zero to 130. Up to 80 of the points are based on their effectiveness in prolonging lives, delaying the worsening of cancer, or shrinking tumors. Then up to 20 points can be added or subtracted based on side effects. And up to 30 bonus points can be granted if the drug relieves cancer symptoms or allows a patient to go without treatment for a period of time.
The costs are listed separately, rather than incorporated into the final score. That is a step short of what is done in some evaluations, such as those by the National Institute for Health and Care Excellence in Britain, in which drugs are rated by the cost per extra year of life they provide, adjusted by side effects and symptoms.
Researchers at Memorial Sloan Kettering Cancer Center recently announced a tool that allows people to evaluate the cost-effectiveness of cancer drugs. The cardiology societies have also said they will evaluate drugs using the cost per year gained of quality life.
Schnipper, chairman of the task force that developed the framework, said patients wanted to know how medically effective a drug is. Adding the cost into an overall rating would obscure that information, he said.