Saunders Katherine, Mably Mary S, Shull Sara S, Jones Heather, Leal Ticiana A, Bergsbaken Jason J
1 Augusta University Medical Center, Augusta, GA, USA.
2 University of Wisconsin Hospital and Clinics, Madison, WI, USA.
J Oncol Pharm Pract. 2019 Jun;25(4):947-953. doi: 10.1177/1078155218815741. Epub 2018 Nov 27.
Cancer treatment costs in the United States are rising. Evidence suggests that increased costs do not always correlate with improved outcomes. Several organizations have developed tools and frameworks to assess cancer treatment value; however, many centers have reported difficulty in implementing these tools and effectively incorporating value-based decision making into clinical practice. After evaluating existing frameworks, the Carbone Cancer Center at UW Health set out to create a value-based tool that could be used to inform the decisions of clinicians and patients. This tool was piloted in metastatic or advanced non-small cell lung cancer, specifically in the second-line setting to assess the value of immune checkpoint inhibitors nivolumab, atezolizumab, and pembrolizumab. The results of the pilot suggest that atezolizumab is the best value of the three agents in this patient population. Challenges and opportunities for improvement that were identified during the pilot process have helped refine the tool for use in a variety of disease states within oncology.
美国的癌症治疗费用正在上涨。有证据表明，费用增加并不总是与治疗效果改善相关。几个组织已经开发了评估癌症治疗价值的工具和框架；然而，许多中心报告称在实施这些工具以及将基于价值的决策有效纳入临床实践方面存在困难。在评估现有框架之后，威斯康星大学健康系统的卡本癌症中心着手创建一种基于价值的工具，该工具可用于为临床医生和患者的决策提供参考。该工具在转移性或晚期非小细胞肺癌中进行了试点，特别是在二线治疗中，以评估免疫检查点抑制剂纳武单抗、阿特珠单抗和帕博利珠单抗的价值。试点结果表明，在该患者群体中，阿特珠单抗是这三种药物中性价比最高的。在试点过程中发现的改进挑战和机遇有助于完善该工具，以便在肿瘤学的各种疾病状态中使用。
