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ASCO's Conceptual Value Framework Released: Tool for Shared Decision Making

Surabhi Dangi-Garimella, PhD
A framework that primarily considers clinical benefit, toxicity, and cost of new treatments was released today by ASCO. A presscast complementing the release described the framework as a tool for providers to discuss value of new treatments with patients, compared with the standard of care.
The American Society of Clinical Oncology's (ASCO's) Value in Cancer Care Task Force has carved a conceptual framework for new cancer treatments based on their clinical benefit, toxicity, and cost compared with the available standard of care. Published in the Journal of Clinical Oncology, the framework can be used by physicians as they discuss new treatments with their patients.

The task force received input from oncologists, patient advocates, representatives from the payer community, as well as the pharmaceutical industry, and is currently open for feedback.

In a press release, ASCO's president Julie M. Vose, MD, MBA, FASCO, said, "Value and cost are among the biggest issues in healthcare today, but there are few tools to help doctors and patients objectively assess benefits, side effects, and costs. Our goal is to help oncologists and their patients weigh potential treatment options based on high-quality scientific evidence and a thoughtful assessment of each patient's needs and goals. In publishing this initial version of the framework, just the beginning of the process, we hope to drive discussion and debate about a critically important issue."

Value of care has been high on the agenda every year at ASCO's annual meeting.This year too, the annual meeting held a panel discussion that included an ASCO representative, a provider, a payer, and a representative from a patient advocacy group. Interest in this session was obvious, with multiple "overflow" rooms needed for the audience.

The value framework deviced by ASCO considers the clinical benefits and side effects of treatments to calculate the "Net Health Benefit" (NHB) score—benefit of the new treatment over existing standard of care. While overall survival and progression-free survival are used in NHB calculations, for patients with advanced cancer, symptom relief and wider treatment-free periods yield the regimen a higher NHB score. However, patient-reported outcomes do not find a place on this framework due to lack of validation.

The NHB would help patients make "value" decisions, which, according to Lowell E. Schnipper, MD, FASCO, chair of the task force, may not necessarily be a cost-effective option. It will however, help personalize a treatment for a patient, with consideration for the patient's needs and goals of care.

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