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ASCO’s Framework: Value at the Crossroads

Many of the observations and recommendations in the ASCO value framework are sound, but significant work remains to be done.

Randy BurkholderJune 23, 2015

ASCO’s Framework: Value at the Crossroads

Yesterday the American Society of Clinical Oncology (ASCO) released its long-awaited draft conceptual framework to assess the value of cancer treatment options.

PhRMA has long supported the development and use of sound tools that enable informed decision-making by patients and providers, which is foundational for fostering efficient delivery of high-quality, patient-centered care. We also appreciate the challenges of developing sound tools – both in terms of conveying the right information at the right time, and making sure they are used to empower patient choices rather than limiting them.

We commend ASCO for the considerable work it has put in to its value framework. ASCO’s call to focus value on the patient-physician interaction echoes the conclusions made by leaders from across the cancer community in recent journal articles, which call for moving “beyond traditional approaches to comparative effectiveness research and health technology assessments to achieve better alignment with patient needs and values, as well as with the emerging science and changing clinical practice of oncology." We hope that ASCO continues to move the framework in a direction that is focused on patient values and physician-patient decision-making rather than shifting to focus on payer decision making and average value.

ASCO-1

While many of the observations and recommendations in the ASCO value framework are sound, significant work remains to be done.

Key issues ASCO will need to address in building a patient-centric tool include:

  • Account for individual patients’ preferences and goals. The value framework presents several key issues related to how patient preferences will or will not be incorporated. A study published in Health Affairs asked patients to compare two treatment regimens for melanoma that, statistically speaking, yielded equivalent survival gains.  However, when one regimen provides assurance of a shorter survival gain, and one offers a 50% chance of twice the survival gain, a large majority of cancer patients chose the latter. Such choices are not easily captured in a value framework like ASCO’s, which may present these regimens as equivalent to a patient. Failure to capture these nuances also increases the risk of the framework being misapplied by policy-makers.
  • Integrate patient-centered information into assessments of value. We appreciate the challenges of including patient-reported outcomes and quality of life endpoints in a value framework. Yet these endpoints can be very important considerations in making treatment decisions.  As ASCO’s framework is finalized and further developed, it should find ways to include these endpoints.
  • Convey information that is relevant for the patient. Decision-support tools need to help patients understand what available evidence means for them individually in their treatment.  While the framework recognizes the importance of this concept, some of the specific examples suggest that in practice there is more work to be done. For example, the example using pemetrexed relies on data from a broader patient population than indicated in the FDA label, which misrepresents the assessment of net health benefit and makes it harder for individual patients to understand what the available evidence means for them.

PhRMA looks forward to engaging others in the cancer community in a dialogue about the development of sound, timely, patient-centric decision support tools.

Read PhRMA's statement on the ASCO Value Framework here.

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