A recent article in the Journal of Clinical Oncology, presented at the 2015 ASCO conference, has put forward a “scorecard” for judging oncology medications to be used by physicians and patients. This scorecard was put together by an ASCO task force and is the culmination of over 8 years of work. The task force’s objective was to create a tool that could be read and interpreted by both physicians and patients and could guide discussion about treatment options. The scorecard assigns a value from 0 to 100 (in some cases 0 to 130) based on the efficacy and side effect profile along with the price for all treatment options.
The article makes the case that a scorecard is necessary for patients and physicians because: healthcare costs (in oncology especially) are growing faster than the clinical benefits, patients are now, and will continue to be, more responsible for costs associated with treatment via high deductibles and/or high co-payments, and there is a growing need for information that weighs the financial cost of oncology drugs against their associated clinical benefits.
One of the larger impacts of this scorecard could be a larger role for patients in making treatment decisions in oncology. Oncologists will always be heavily involved in guiding the treatment of their patients, but this new scorecard will make treatment information much more accessible for patients. Patients will be able to compare the efficacy, cost, and side effects of two or more treatments side-by-side. With more accessible information and data on specific treatment regimens, patients will be better equipped to weigh the relative tradeoffs of new drugs. Patients may play a larger role in deciding if added efficacy is worth the financial cost, if they are willing to tolerate certain side effects, and other decisions that inevitably arise during the course of treatment. Knowing this, pharmaceutical companies should continue to invest in market research on patient perceptions of price and patient willingness to pay prior to the launch of new agents.
Payers may also be impacted by the release of this scorecard. Many payers have traditionally taken a “hands-off” approach to oncology with little restriction. Recently though, payers are keeping a closer eye on spending in oncology, especially as spending continues to rise in this therapeutic area. In the UK, the National Institute for Health and Care Excellence (NICE) has been taking this approach for some time. Any treatment, not just in oncology, needs to be approved by NICE and needs to show that the clinical benefit of the drug justifies the price. However, the UK employs a single-payer healthcare system, which is very different from the current healthcare system in the USA. That being said, it’s not difficult to imagine American payers taking a similar approach in the future. This scorecard may even lay some of the ground work for US payers in evaluating the oncology drugs. The release of this scorecard also at least hints that oncologists and payers are getting closer to sharing the perspective that the cost of an oncology drug should be supported by its clinical benefits.
It’s also not difficult to imagine how this scorecard might impact other therapeutic areas in the years to come. Other diseases such as rheumatoid arthritis, psoriasis, and ankylosing spondylitis, which are mainly treated with high-cost biologic drugs, could be another area where this kind of scorecard might be useful for patients, physicians, and even payers. It would certainly allow for more open dialogue around efficacy, cost, and side effects for patients and their physicians. It might also lead to a framework that payers can use for coverage decisions.
The release of this scorecard will likely come under some amount of scrutiny and criticism as physicians and patients begin to use it as a guide when making treatment decisions. In fact, the authors of the scorecard are currently inviting feedback on how it can be revised to become a better tool for physicians and patients. Having more tools like this can only help patients have a better and more concrete view of how cancer treatments are likely to impact both their health and their finances. Maybe US payers will use something like this for their own coverage decisions and maybe other associations like ASCO will release scorecards for other therapeutic areas.