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Facts Are Stubborn Things: The Medicare Part B Experiment, a Patient Advocate's Perspective (Part III)

Why this patient advocate is concerned about the newly proposed Medicare Part B model regarding its level of transparency and the evidence.
In fact, in addition to ICER, several groups are facing the reality of financial toxicity head on and developing value frameworks and tools, including the American Society of Clinical Oncology (ASCO)’s Value Framework and the National Comprehensive Cancer Network (NCCN)’s Evidence Blocks, where the costs and affordability of treatment are included in addition to the NCCN Guidelines’ standard measures of efficacy, toxicity, and quality of associated clinical research data. In addition, a growing number of oncologists have begun to push back concerning the prohibitively high costs of new cancer drugs, such as by being vocal about not prescribing new “me too” cancer drugs that are extremely expensive yet provide little or no added benefit for patients.  Peter Bach, MD, MAPP, and 2 colleagues publically announced the following in a New York Times editorial, “At Memorial Sloan-Kettering Cancer Center, we recently made a decision that should have been a no-brainer: we are not going to give a phenomenally expensive new cancer drug to our patients. The reasons are simple: the drug, Zaltrap, has proved to be no better than a similar medicine we already have for advanced colorectal cancer, while its price—at $11,063 on average for a month of treatment—is more than twice as high.” They stressed that when determining specific treatment protocols for patients, it’s critical for clinicians to take into account the financial strain that could result in addition to the treatment’s benefits.

So in conclusion, my fear is that the importance of ICER’s contributions and those of other groups like those described above are being overshadowed by or inappropriately drawn into the discussion concerning the many flaws in the first portion of the proposed CMS Part B Payment Model. Rather, I’d suggest that CMS would gain much by eliminating the first portion of the proposal, which appears to be solely cost-driven and formulated without any critical stakeholder input, and/or potentially replacing it with a voluntary, transparent, stakeholder-driven demonstration project, such as based on the model described by Newcomer et al, above. And further, my hope is that an increasing number of patients, clinicians, advocacy groups, and clinical specialty societies will recognize and support the need for independent, transparent, evidence-based, and patient-centered analyses of value such as those driven by ICER, ASCO, and NCCN as a firm foundation for evidence-based practice for optimal patient care and outcomes. I leave you with David Sackett’s and his colleagues’ well-known description of evidence-based practice, which perhaps best describes what should be at the heart of care for all of those who are patients—in other words, for us all.

Evidence-based practice is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient…[It] is the integration of clinical expertise, patient values, and the best research evidence into the decision making process for patient care.”
~David Sackett

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