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Defining the Notion of Value in Oncology Treatment
The last decade has brought considerable innovation in oncology pharmaceuticals, increasing survival and sometimes providing a cancer cure. Nevertheless, high costs and obstacles to access have reduced the impact of these innovations. As a result, some analysts have concluded that many new treatments are not priced in keeping with the value they provide.
However, according to Richard Willke, PhD, International Society for Pharmacoeconomics and Outcomes Research, Lawrenceville, NJ, and colleagues, innovations in cancer treatment demand equivalent innovations in value determinations. To provide a framework for these innovations, Dr Willke and colleagues recently published an introduction to considerations in value assessments specific to oncology (J Manag Care Spec Pharm. 2022;28(3):362-368. doi:10.18553/jmcp.2022.21153).
After addressing the main limitations of quality-adjusted life-years (QALYs) in cost-effectiveness analyses, Dr Willke and colleagues provided a checklist of novel value elements that capture patient and social preferences not covered by QALYs and the applicability of these elements to value determinations in oncology. These elements capture aspects of patient preferences such as risk aversion not typically included in QALY measurement. However, they merit consideration because they help to determine how patients behave, the decisions they make, and their willingness to pay.
One key value element for patients is the severity of the disease, which may confer a high risk of rapid death or result in low health-related quality of life. Another is the value of hope, which comes into play with treatments that may cure a considerable proportion of cancers even though their effect in most cases may be limited.
Another key value element is reducing the uncertainty in the diagnosis by using companion diagnostics, which can enable more efficient treatment and lower costs and is therefore relevant to payers and the healthcare sector at large as well as to patients.
The value of equity is another key consideration from the perspective of society as a whole. Although more equitable treatment may not affect QALYs or decrease costs, it meets the social need to improve fairness in treatment allocation, especially for cancers that are most prevalent in low-income or disadvantaged populations.
The experts also cite two main kinds of evidence that can assist in the valuation of oncology treatment. The first is the evidence offered by stated preference studies, which can provide estimates of a patient’s willingness to pay for specific benefits. Health economic analysis can then incorporate the value of these benefits into a calculation comparable to cost-effectiveness estimates. Another approach is multicriteria decision analyses, which can be used to incorporate different aspects of value in a metric comparable across treatments for a specific disease.
“Because cancer is often a severe and expensive disease, the potential importance of novel value elements in economic evaluations of oncology products seems high and should be further explored,” Dr Willke and colleagues concluded, adding, “[I]t is important for value assessments to capture the full value of treatments to patients and society so that pricing and reimbursement decisions properly incentivize their development.”
