Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, New York, NY, USA.
Yale University School of Medicine, New Haven, CT, USA.
Pharmacoeconomics. 2020 Jul;38(7):737-745. doi: 10.1007/s40273-020-00901-x.
The National Comprehensive Cancer Network (NCCN) Guidelines' Evidence Blocks has the broadest scope of the several oncology value assessment frameworks. The Evidence Blocks includes the Affordability criterion, which reflects the financial cost of each treatment on a 1-5 scale. The accuracy of Affordability is unknown.
We calculated Medicare costs for all first-line and maintenance treatments for the 30 cancers with the highest incidence in the USA that had published NCCN Evidence Blocks as of 31 December 2018. We assessed the accuracy and consistency of Affordability across different treatments and cancer types. Among different treatments for the same indication, we determined the frequency with which the Affordability assessment was consistent with calculated treatment costs.
There were a total of 1386 treatments in our sample. Lower Affordability scores were associated with higher costs. There was significant variation in cost at each level of Affordability; for treatments with Affordability = 1 (very expensive), costs ranged from $US4551 to $US43,794 per month for treatments administered over an undefined time period and from $US2865 to $US500,982 per course of therapy for treatments administered over a defined time period. Among treatments for the same indication, Affordability was discrepant with calculated treatment costs in 7.9% of pairwise comparisons, identifying the higher-cost treatment as being more affordable. Discrepancies were reduced when we reassigned Affordability scores based on calculated treatment costs.
Evidence Blocks Affordability generally correlated with treatment costs but contained discrepancies, which may limit its usefulness to clinicians in comparing costs. This study suggests that the Affordability score may be improved by indexing more directly to specified dollar value thresholds.
国家综合癌症网络（NCCN）指南的证据块具有几种肿瘤学价值评估框架中最广泛的范围。证据块包括负担能力标准，该标准反映了每个治疗方案在 1-5 范围内的财务成本。负担能力的准确性尚不清楚。
我们计算了截至 2018 年 12 月 31 日发布 NCCN 证据块的美国发病率最高的 30 种癌症的所有一线和维持治疗的医疗保险费用。我们评估了负担能力在不同治疗方案和癌症类型中的准确性和一致性。对于同一适应症的不同治疗方案，我们确定了负担能力评估与计算的治疗费用一致的频率。
我们的样本中共有 1386 种治疗方法。较低的负担能力评分与较高的成本相关。在每个负担能力水平都存在显著的成本差异；对于负担能力为 1（非常昂贵）的治疗方案，在未定义时间内给予治疗的每月费用范围为 4551 至 43794 美元，在定义时间内给予治疗的每个疗程费用范围为 2865 至 500982 美元。对于同一适应症的治疗方案，负担能力与计算的治疗费用在 7.9%的成对比较中存在差异，将成本较高的治疗方案视为更负担得起的方案。当我们根据计算的治疗成本重新分配负担能力评分时，差异会减少。
证据块的负担能力通常与治疗成本相关，但存在差异，这可能限制其在比较成本方面对临床医生的有用性。本研究表明，通过更直接地将负担能力评分与指定的美元价值阈值相关联，可能会改善负担能力评分。
