Dr Scott Ramsey on Challenges of Determining Cost Effectiveness of Novel Cancer Treatments

Scott Ramsey, MD, PhD, of Fred Hutchinson Cancer Research Center, discusses determining cost effectiveness of novel treatments, such as immuno-oncology agents, and potential solutions to reducing financial toxicity in cancer care.

In what ways would the current standard survival modeling be inadequate for determining cost effectiveness of novel treatments that cure or produce substantially longer term responses?
Standard survival modeling relies on the distribution of survival that can be easily modeled with common functional forms. And what we’re learning with some of the new immuno-oncology agents is that there can be, in some cases, a fraction of patients who have long-term responses, and in effect, cures, such that their survival approach is that of the normal population without the disease. These are very hard to capture—essentially impossible to capture—with standard survival modeling techniques, so cure model fractions were developed to try to address this problem.

With the cost of cancer steadily increasing, what, if any, solutions do you see that could reduce financial toxicity?
I do have hope that value-based pricing or performance-based pricing might be one way to address the problem of financial toxicity. I think it's also important for the insurance community, which is turning more of the cost of care over to patients, understand that for oncology this is creating tremendous burdens. So it will be a variety of solutions, both on the payer side, on the manufacturer side, and also on the physician and patient side to make better decisions so that problem is mitigated.
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