New high-priced cancer treatments rarely demonstrate value, compared with the prices being charged for them.
Researchers examined clinical trial data for new treatments using scoring frameworks developed by both the American Society of Clinical Oncology (ASCO) and the European Society for Medical Oncology (ESMO) that assess the value of cancer therapies by taking into consideration survival gains in relation to toxicity and quality. Findings were simultaneously published online June 2 in The Lancet Oncology (2017 June 2. doi: 10.1016/S1470-2045(17)30415-1) and presented at the annual meeting of the American Society of Clinical Oncology.
One of the findings from the research quantified the magnitude of how much benefit a new treatment offers patients.
“We were able to compare that across different treatments and we were able to calculate the drug cost per month of treatment with each new cancer treatment,” Christopher Booth, MD, of Queen’s University Cancer Research Institute, Kingston, Ont., and one of the report’s authors, said in an interview.
“We looked to see whether there is a relationship between cost and benefit. In most elements of our economy, if something is of higher value and better quality, we often pay more for it as opposed to something that offers less quality or less value,” he continued. “We found that that relationship does not hold true in the world of cancer drugs. In fact, if anything, we saw an inverse association, meaning that the drugs that are the most expensive actually have the smallest benefit for patients. That is probably the most important finding of the work.”
Dr. Booth suggested that this has to do with the fact that value is never a factor in pricing.
“In very general terms, the way that a new drug is priced is effectively the highest price the market will bear,” he said. “There really isn’t an approach currently to price drugs based on the return that they offer to patients and society. There is a conversation under way within the oncology community about whether we need to be shifting that conversation to something perhaps called value-based pricing where treatments that offer greater benefit to patients are priced higher than treatments that offer negligible benefit.”
He also noted that “there is not a lot of incentive for the research community or pharmaceutical companies to identify drugs that have larger and larger benefits, being that the financial return on their investment does not appear to be related to how much benefit the drug offers. If we shifted that conversation, it would hopefully, at least in some way, drive the research community and push us to find treatments that have large or meaningful benefits to patients instead of some of these treatments that are very expensive with important side effects that really offer very small improvements in patient outcomes.”
Dr. Booth continued: “I think it’s inevitable and I think what these score cards are doing, and even though they are not perfect, are getting the conversation into the mainstream and for the first time allowing oncologists and researchers and policy makers to start some kind of comparative analyses looking at one treatment compared to the other in the same disease setting as offering a greater or lesser benefit to patients,” which is an important conversation as health care systems are faced with stretching their limited resources to help the populations they serve.
The other key finding of the report was the lack of correlation between the scores yielded by the ASCO Value Framework and the ESMO Magnitude of Clinical Benefit Scale.
“We looked at a number of randomized trials of new cancer treatments and we scored them using the European approach and the American approach and found that there is actually fairly little agreement between the two systems,” Dr. Booth said.
The cause, he suggested, was tied to differences in methodology between the two systems, though he noted that both frameworks are evolving and “I suspect there will be convergence over time.”