Would you choose to live a few weeks longer if it cost your family upwards of $10,000? What about a longer lifespan with a price tag that came in the form of difficult side effects?
A new decision guide, published Monday by the American Society of Clinical Oncology, seeks to help patients facing these types of devastating decisions by providing more clarity on the impact of new cancer drugs on health outcomes, side effects and finances.
The proposed methodology aims to make it easier for patients and providers to make more-informed decisions about care.
“This project is responding to patient concerns, as well as society’s concerns, about the rising costs of medical care, specifically cancer care, that make optimal care challenging at best and prohibitive in other cases,” said Dr. Gary Lyman, co-director of the Hutchinson Institute for Cancer Outcomes Research at Fred Hutch and member of the ASCO Value in Cancer Care Task Force that created the framework.
The ASCO Value Framework assigns a score, called a “Net Health Benefit,” to new drugs based on how they’ve stacked up against the current standard of care in randomized controlled trials. A new drug gets points for helping patients survive longer than the old therapy and for having less-severe side effects.
The framework provides the drug costs along with the Net Health Benefit so patients and their doctors can consider medical benefits side by side with the financial impact when choosing a course of therapy.
The framework’s authors demonstrated its use in metastatic lung cancer, advanced multiple myeloma, metastatic prostate cancer and HER2-positive breast cancer. As currently published, it is geared more toward physicians than for use by patients (with published results from a clinical trial in hand, users fill out a worksheet to derive a drug’s Net Health Benefit). But eventually, ASCO said in a statement, the goal is for the framework to serve as the basis for user-friendly tools that physicians and patients could use together to choose treatments based on the patient’s individual values and preferences for care. In fact, Lyman said, the task force envisions an electronic tool that integrates up-to-date information on benefits, harms and costs seamlessly into electronic health records.
“When all three elements are considered” — clinical outcomes, toxicity and cost — “distinct differences in the available options often emerge,” Lyman said. “It’s not telling people to take one agent or another, but rather to enhance the discussion between patient and provider.”