Slomiany Mark, Madhavan Priya, Kuehn Michael, Richardson Sasha
Consultant, Market Access Health, GfK, New York, NY.
Senior Analyst, Market Access Health, GfK, New York, NY.
Am Health Drug Benefits. 2017 Jul;10(5):253-260.
As the cost of oncology care continues to rise, composite value models that variably capture the diverse concerns of patients, physicians, payers, policymakers, and the pharmaceutical industry have begun to take shape.
To review the capabilities and limitations of 5 of the most notable value frameworks in oncology that have emerged in recent years and to compare their relative value and application among the intended stakeholders.
We compared the methodology of the American Society of Clinical Oncology (ASCO) Value Framework (version 2.0), the National Comprehensive Cancer Network Evidence Blocks, Memorial Sloan Kettering Cancer Center DrugAbacus, the Institute for Clinical and Economic Review Value Assessment Framework, and the European Society for Medical Oncology Magnitude of Clinical Benefit Scale, using a side-by-side comparative approach in terms of the input, scoring methodology, and output of each framework. In addition, we gleaned stakeholder insights about these frameworks and their potential real-world applications through dialogues with physicians and payers, as well as through secondary research and an aggregate analysis of previously published survey results.
The analysis identified several framework-specific themes in their respective focus on clinical trial elements, breadth of evidence, evidence weighting, scoring methodology, and value to stakeholders. Our dialogues with physicians and our aggregate analysis of previous surveys revealed a varying level of awareness of, and use of, each of the value frameworks in clinical practice. For example, although the ASCO Value Framework appears nascent in clinical practice, physicians believe that the frameworks will be more useful in practice in the future as they become more established and as their outputs are more widely accepted.
Along with patients and payers, who bear the burden of treatment costs, physicians and policymakers have waded into the discussion of defining value in oncology care, as well as pharmaceutical companies that seek to understand the impact of these value frameworks on each stakeholder, as they model the value and financial threshold of innovative, high-cost drugs.
随着肿瘤治疗成本持续上升，能不同程度反映患者、医生、支付方、政策制定者及制药行业各种关切的综合价值模型已开始形成。
回顾近年来出现的5种最显著的肿瘤学价值框架的能力与局限性，并比较它们在目标利益相关者中的相对价值及应用情况。
我们采用并排比较法，从每个框架的输入、评分方法和输出方面，对美国临床肿瘤学会（ASCO）价值框架（2.0版）、美国国立综合癌症网络证据模块、纪念斯隆凯特琳癌症中心药物算盘、临床与经济评论学会价值评估框架以及欧洲医学肿瘤学会临床获益程度量表的方法进行了比较。此外，我们通过与医生和支付方的对话，以及二次研究和对先前发表的调查结果的汇总分析，收集了利益相关者对这些框架及其潜在实际应用的见解。
分析确定了几个特定于框架的主题，它们分别侧重于临床试验要素、证据广度、证据权重、评分方法以及对利益相关者的价值。我们与医生的对话以及对先前调查的汇总分析显示，临床实践中对每个价值框架的认知和使用程度各不相同。例如，尽管ASCO价值框架在临床实践中似乎尚处于起步阶段，但医生们认为，随着这些框架更加成熟且其结果被更广泛接受，它们在未来的实践中将更有用。
与承担治疗成本负担的患者和支付方一样，医生和政策制定者也已深入参与到肿瘤治疗价值定义的讨论中，制药公司在对创新型高成本药物的价值和财务阈值进行建模时，也试图了解这些价值框架对每个利益相关者的影响。
