When deciding on a treatment strategy, cost is sometimes the elephant in the room. Patients can be embarrased to bring up the subject to their physician. Doctors feel discussing price might imply that the patient won’t receive the best possible care if their budget is limited. To counter this, different cancer organizations have created tools to guide patients, physicians and policy makers in choosing the best treatment. For the first time, these also include financial considerations.
The context
In the current trend towards patient centricity in healthcare, all stakeholders invest in ways to involve the patient in treatment decisions. More insight and participation lead to more trust in the therapy and more treatment satisfaction. This has resulted in the development of an increasing number of tools used to support the communication between physician and patient, and streamline the process of discussing and choosing a treatment plan, such as the Option Grid system.
The nuts and bolts
Recent examples of systems focused on value include the National Comprehensive Cancer Network’s Evidence BlocksTM, the American Society of Clinical Oncology’s Value Framework, the Institute for Clinical and Economic Review’s Value Assessment Framework, the European Society for Medical Oncology’s Magnitude of Clinical Benefits Scale (MCBS) and the Memorial Sloan-Kettering Cancer Center’s DrugAbacus. All systems include evaluations of efficacy or survival and potential toxic effects. They allow a personalization of treatment based on the patient’s values, but each place different accents and priorities. In terms of the financial aspect, some include affordability in the overall evaluation, while others keep it separate and optional. The considered price can range from merely the out-of-pocket cost of the drug to a full package including supportive care, infusions, monitoring of toxic effects, hospital care if needed and more. The ICER system also takes into account any cost savings due to lower hospitalization rates or less time away from work.
How will this help me?
The reactions from providers and patient advocates to systems guiding treatment choices are mixed. As they are new, it will take some time to get integrated into clinical practice where they will show their value. Doctors dislike the idea of cookbook medicine as they fear such system overrules their clinical judgement. In any case, more and better information for the patient will lead to smoother conversations with the physician. The fine-tuning and increased use of these systems will stimulate more brief and insightful conversations between all parties involved in weighing treatment options. Such systems will cover all important considerations and will help patients take more control over their situation.
Source
Caroline McNeil – Deciding on Therapy: New Tools Factor In Cost of Care – Journal of the National Cancer Institute (2016).