ASCO Addresses High Cost of Cancer Drugs

Roxanne Nelson, BSN, RN

July 19, 2017

The issue of expensive cancer therapies is taken up by the American Society of Clinical Oncology (ASCO) in a new position statement that offers several possible solutions to make drugs more affordable.

"We need our nation's leaders to tackle the major drivers of patients' cost burdens, including rising prices," said ASCO Chief Executive Officer Clifford A. Hudis, MD.

"In what, undoubtedly, is one of the most difficult times in their lives, individuals with cancer should be focused on getting the best care possible, not worrying about financial strain on their families," he added.

The price tags of cancer drugs has been steadily rising, and prices in the United States are the highest in the world.

What to do about this has been a hot topic of discussion for some time. In the new statement, ASCO analyzes the various options that have been proposed. It recommends that a panel of stakeholders be established to determine which of these may be effective and to develop a uniform approach for assessing the value of drugs.

Any solution must preserve access to care and foster innovation, it emphasizes.

Proposals

"We propose a number of modest 'experiments' to determine if any model can help rein in drug costs without jeopardizing innovation or access to care," ASCO says.

These include testing various proposals, including value-based pathways, indication-specific pricing, and outcomes-based pricing.

ASCO also supports the use of generics and biosimilar drugs, and says the proposals to give Medicare more power to negotiate prices is worthy of consideration.

The society states that it is opposed to bundle payments or tiered formularies.

There is no simple solution to escalating drug prices.

"There is no simple solution to escalating drug prices, and many differing views on what constitutes value in cancer treatment," it comments.

All of the stakeholders must be involved, ASCO says. The larger community, which includes providers, patient advocates, payers, hospitals, experts in health economics and health outcomes, representatives from the pharmaceutical and biotechnology industries, members of Congress, and administration policy makers, must actively participate in any effort to develop policy solutions to address the affordability of cancer drugs.

Congress and the administration can play an important role in bringing together a diverse group of experts to identify, evaluate, and prioritize a series of demonstrations designed to test some of the solutions that have been highlighted in the new statement. Once they are tested, implementation should be recommended for those that are successful.

Cost and Value

There needs to be a "real and consistent" relationship between cost and the benefits of a drug, the society says.

To establish that, ASCO developed a value framework, which defines the value of a drug as a measure of clinical benefit, toxicity, and cost. The framework was first proposed in June 2015 and was updated in May 2016. The goal for this year is to further improve the framework's methodology. Currently, the tool is only able to evaluate drugs that were studied head to head in prospective, randomized clinical trials; ASCO is working to include cross-trial comparisons.

A similar value framework has been developed by the European Society for Medical Oncology.

Other major initiatives to control cost that have been proposed over that past few years include the Drug Abacus, designed by Peter Bach, MD, director of the Center for Health Policy and Outcomes at Memorial Sloan Kettering Cancer Center, in New York City, and the value initiative developed by the National Comprehensive Cancer Network (NCCN), NCCN Evidence Blocks.

ASCO. American Society of Clinical Oncology Position Statement on Addressing the Affordability of Cancer Drugs. Published online July 19, 2017. Full text

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