Bruce A. Feinberg, DO: You could argue that the reason the patient has been punished as the recipient of care is the rising co-pays and the rising deductibles; and you could argue that the reason for that is because much of this is just so complicated, and so difficult to manage, and so lost in regulatory issues, that there’s low-hanging fruit. The low-hanging fruit happens to be the one element in the cost profile that has had the most egregious increase over time—over the last decade. That comes back to drugs.
You can see why drugs have been picked, and they’re in the center of the target. So we now have these 4 different tools (more to come), and I thought it would be good to finally bring them out in the open and talk about them. I would probably go in the order in which they were released: DrugAbacus came out first, ASCO Value Framework second, NCCN Evidence Blocks came out third, and now ICER. Who wants to give a first stab at just giving that quick 1-minute capsule summary? We’ll start with DrugAbacus. Let’s explain what those little dials are, right?
Ted Okon, MBA: The little dials are looking at the components of, basically, value. It goes to, literally, the cost of the drug. Now, I really don’t know what the cost of the drug is to Memorial Sloan Kettering.
Bruce A. Feinberg, DO: But the dials are valuing efficacy and toxicity?
Ted Okon, MBA: Exactly. The one [component] that Dr. Bach left off was the site of service. He left off moving that dial because that dial is dramatically different in terms of where the site of service is. But I don’t know, and I haven’t spoken to an oncologist that has ever looked at this and said, number 1, they can really figure it out, and number 2, that it’s useful. I think the same is true for a patient. So I agree with Mike, that I think it was more meant to basically help Dr. Bach on his soapbox. There’s a problem with drug prices, and therefore, companies need to do something different. You can compare different drugs. I really don’t know, other than that, how useful the DrugAbacus is.
Michael Kolodziej, MD: I don’t think it’s got to do with the soapbox. I think what it’s got to do with is heading toward indication-specific pricing or determining (based on whatever objective criteria is included in the tool) other therapeutic options for that disease or class. What price is justified by the best-available evidence? That’s all it is in my mind. It is not designed for doctors to use, and it’s certainly not designed for patients to access—it’s designed for a dialogue, I think, between perhaps payers, or Medicare, or some other third party with the innovators.
Ted Okon, MBA: What’s the value there, especially when you have one individual at one institution that’s sort of determining what some of those are?
Michael Kolodziej, MD: That’s why the dials make a difference. You can personalize relative significance.
Ted Okon, MBA: Right—to a degree. There are parameters.
Bruce A. Feinberg, DO: The concept of the dials is that you’re going to assign a value to each of the components.
Michael Kolodziej, MD: Efficacy is the most important thing to me. Crank it up.
Bruce A. Feinberg, DO: Right. Crank up efficacy. Toxicity may be a little bit lower. Innovation is one of the dials—how innovative is this? How unique of a population is it that’s being treated with a rare disease? Does that elevate the need or the unmet need and therefore have greater value? So, I think there were some merits in the concept, but I agree with you in terms of asking who uses that tool. Where does that tool have value in the healthcare economy? It’s unclear.