June 27, 2018
A recent commentary in JAMA Oncology outlined the creation of the ASCO comprehensive cost of care task force to help physicians and patients tackle the increasing imbalance in health care costs and health coverage.
Joshua D Palmer, MD, of the James Cancer Hospital and Solove Research Institute at the Ohio State University Wexner Medical Center, and colleagues outlined the financial burden landscape that physicians, patients, and society face.
“Health care reform grossly addresses societal financial burden but often undermines the significant financial hardship experienced by patients with chronic illnesses,” they wrote. “Patients with cancer are especially vulnerable and bear higher out-of-pocket costs than do patients with other chronic illnesses.”
Dr Palmer and colleagues explained that cancer care is particularly burdensome because of the immense financial fallout created by the need to constantly improve cancer treatment. New, high-cost products offer better health outcomes, but come at the cost of decreased quality of life due to financial strain. They said studies have shown financial burden to be “the strongest independent predictor of poor quality of life, negatively affecting patients’ physical health, mental health, and satisfaction with relationships.”
They also explained that recent policy changes by the Trump Administration could cause additional financial burden for cancer patients.
“President Trump recently signed an executive order that expanded access to association health care plans that offer lower cost and minimum coverage by bypassing some ACA protections,” Dr Palmer and colleagues wrote. “This order could potentially offset the risk pool and result in insurers exiting the ACA marketplace, further leaving those with serious medical conditions vulnerable. Regardless of how policy debates evolve, it is vital for physicians to “first, do no harm.” This ethical obligation should encompass financial harm, too, because its debilitating consequences are becoming increasingly recognized.”
The Task Force
Dr Palmer and colleagues said that these issues led the American Society of Clinical Oncology (ASCO) to form a national Cost of Care Task Force.
Under the Task Force, ASCO participated in the Choosing Wisely campaign and identified numerous therapies and tests that do not provide value. The Task Force also developed a model that determines the net health benefit of one drug regimen compared with another equivalent regimen. This model helps determine which regimen is more clinically and financially valuable—giving patients and oncologists increased access to cost per added QALY information.
Additionally, the National Comprehensive Cancer Network (NCCN) expanded the definition of value—which now includes affordability, in order to give patients better decision-making data.
“Although still in its infancy, ASCO’s initiative to tackle the issue marks an important step, and the medical oncology community has been active in publishing financial burden information and in developing decision-making tools,” the authors wrote. “An organized effort by a dedicated task force could more aggressively explore innovative ways to define value and supplement current value-based treatment decisions.”
As a next step, Dr Palmer and colleagues suggested the creation of a database to improve price transparency and cost-based decision making.
“A database that tracks the most frequent cancers and cancer treatments with their corresponding costs could direct researchers to study whether a less costly protocol also saves the most lives,” they wrote.
They concluded that the task force could also improve legislation lobbying efforts to reduce cost-sharing burdens, tackle the imbalance between health care costs and coverage, and improve the availability of guidelines that incorporate cost-of-care into treatment recommendations.
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