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April 17, 2014

Doctors to rate cost effectiveness of expensive cancer drugs

NEW YORK — The world's largest organization of cancer doctors plans to rate the cost effectiveness of expensive oncology drugs, and will urge physicians to use the ratings to discuss the costs with their patients.

The American Society of Clinical Oncology is weighing efficacy, side effects and price using an algorithm to determine the relative value of drugs, focusing first on therapies for advanced cases of lung and prostate cancer and for multiple myeloma, said Richard Schilsky, the group's chief medical officer. The task force developing the system plans to present it for public comment later this year, he said.

With the price of many cancer regimens reaching $10,000 a month, doctors need to communicate the medical implications of their care and, increasingly, the cost so patients can make the best decisions for themselves and their families, panel members said.

"Cancer is one of the primary reasons families go bankrupt today," said Gary Lyman, an oncologist at the Fred Hutchinson Cancer Research Center in Seattle and a member of the task force. "Often families are mortgaging their houses to pay for these expensive drugs. We want to make sure families understand both the benefits of what we can do, and the financial impact."

Too often, those who can't afford a medicine "either go elsewhere and get inferior treatment, or they stop treatment altogether because they're embarrassed to be poor," he said.

While companies including London-based AstraZeneca, a maker of cancer drugs, and UnitedHealth Group Inc., the largest U.S. health insurer, have representatives working with the panel, the "sense" of the members is that the cancer physicians "need to be in the driver's seat here," Lyman said in a telephone interview.

The task force, set to meet Thursday, doesn't plan to publish long lists of value ratings, Schilsky said. Rather, the aim is to provide the framework for a scoring system that will give doctors and patients options to discuss in determining how to proceed with care.

"We realize this is an important and somewhat sensitive issue," Schilsky said in a telephone interview. "ASCO is not setting itself up to be some national agency that makes pronouncements" on pricing.

Lowell Schnipper, the task force chairman, said the value ratings may cause drugmakers to reassess their pricing policies.

"My guess is that something like this can have a modulating effect," Schnipper, who is also chief of hematology and oncology at Beth Israel Deaconess Medical Center in Boston, said in an interview. Such a system may keep companies whose drugs are "only a little bit better" from dramatically increasing the price.

ASCO "has been very active in defining guidelines for the appropriate management of problem x, y and z," Schnipper said. "But this is the first time it has ever approached the issue of the value of the treatments we offer."

Once the Alexandria, Va.-based cancer organization comes to a consensus on a rating system, "our hope is that we can expand the range of disease situations that can be included in this kind of analysis," he said.

The task force has been working on the value ratings for the past year, Schilsky said. Eventually, the rating system may be available online so doctors can access them on a hand-held device at the point of therapy, according to Lyman.

"By putting that information in front of the oncologist, we expect it will change behavior," Lyman said.

 

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