Mounting cancer care costs tackled at Value in Cancer Care Summit

More than 70 stakeholders from the world of cancer care met Friday to discuss ways to reduce the burden of cancer costs, a quandary currently being tackled by the newly formed Hutchinson Institute for Cancer Outcomes Research at Fred Hutchinson Cancer Research Center.     

Public and private insurers, oncologists and other health care providers from the region’s leading medical institutions came together at Seattle’s Bell Harbor Maritime Events Center as part of the Value in Cancer Care Summit, an all-day “working meeting” co-sponsored by HICOR and members of the Value in Cancer Care Initiative, a regional consortium of cancer care providers and payers engaged in promoting a dialogue on the topic of value in oncology.

‘One of the edgier things the Hutch has done in a while’
“It’s an out-of-the-box thing and one of the edgier things the Hutch has done in a while,” Dr. Scott Ramsey, co-director of HICOR, said of the summit. Ramsey is an internist and health care economist based in the Public Health Sciences Division at Fred Hutch.

“We’re bringing together insurers and practicing oncologists and providers and hoping to find some common ground for deciding what ‘value’ is in cancer care,” he said. “We want to agree on some metrics that define value and report back to the community and hope it will help people make better decisions about cancer care.”

The summit kicked off with opening remarks from both Ramsey and fellow HICOR co-director Dr. Gary Lyman, a practicing medical oncologist and internationally recognized leader in comparative effectiveness, health services, and outcomes research who recently came to the Hutch from Duke University.

The cost of health care is a ubiquitous discussion, said Lyman, particularly since the U.S. is spending more on health care than any other country in the world. Currently, health spending in the U.S. represents 17.7 percent of the gross domestic product; by 2020 it is expected to jump to 20 percent. Higher spending does not necessarily translate to increased life expectancy, however. What’s more, patients are bearing more and more of the costs.

Cancer care is particularly pricey with costs rising faster than health care overall, said Lyman, who pointed out that in 2010, cost of cancer care hit $125 billion. By 2020, experts project those costs will reach $175 billion.

Cancer drugs make up a substantial slice of the health care cost pie, he said, but they aren’t the only factor driving the rising cost of cancer care.

“It’s a very complicated issue and there are many nuances to it but I think if you look enough at where the U.S. is in terms of health care expenditures, it’s hard to make an argument that we’re making good uses of expenditures across the board,” Lyman said. “So it behooves us to have these discussions and see what we can do to improve the quality of care and bend that cost curve down.”

‘Your perspective on value depends a lot on where you sit’
Ramsey, the author of a recent study on the link between cancer diagnosis and bankruptcy, opened his remarks with a timely analogy for local football fans: a comparison of the “value” of quarterbacks Russell Wilson of the Seattle Seahawks and Peyton Manning of the Denver Broncos.

“Your perspective on value depends a lot on where you sit,” he said, noting that fans and owners may have completely different perspectives. “Russell Wilson came in at about 1/25^th of the cost of Peyton Manning for each season but the outcome for them is the same. They’re both in the Super Bowl. We’ll see who produces the most value in a couple of weeks.”

Ramsey then went on to discuss various points participants should consider when defining value in cancer care, such as duration of life, quality of life, health status, adverse effects, equity and compassion, as well as metrics for assessing value, such as efficiency, effectiveness, necessity, reasonableness and affordability.

He also encouraged summit participants to consider two questions: What do you get when you spend more, and what do you lose when you spend less?

Breast cancer therapy, for instance, is very expensive, he said, “but it’s been shown in multiple studies to improve survival and quality of life. It may be more expensive but it provides a lot of value.”

HICOR is ‘a Switzerland of sorts’
Ramsey went on to talk about the role of the summit and of HICOR, which he sees it as a neutral facilitator and resource, “a Switzerland of sorts.”

“Our contribution today is to open the dialogue, to listen and to facilitate consensus,” he said to the attendees before they broke into groups to discuss value in cancer care and then build a consensus as to what value metrics are most relevant to the Puget Sound region, can be collected easily and efficiently and put to use in a practical way.

“This is your meeting and your discussion,” Ramsey said. “But this is the start of what I hope will be a long-term process to add value to cancer care in our region.”