The American Society of Clinical Oncology has designed a new conceptual framework to help doctors and patients better assess the value of new cancer treatment options based on clinical benefit, side effects, and cost.

The Society said it has published an initial form of the framework, in the Journal of Clinical Oncology, to gather feedback and stimulate discussion on the sharp rise and growing burden of cancer costs in recent years.

New cancer drugs are hitting the US market with an average cost of $10,000 per month, some even as high as $30,000 per month, and many patients are left reeling from the strain because they shoulder a significant share of these costs through health insurance deductibles, co-payments, and other out-of-pocket expenses.

The ASCO Value Framework sets out to calculate a combined Net Health Benefit (NHB) score - based clinical trial data on improvement in overall or progression-free survival and potential side side effects - which represents the added benefit patients can expect to receive from the new therapy versus the current standard of care. 

The NHB is presented alongside the patient’s expected out-of-pocket costs for the regimens being compared, as well as the overall drug acquisition cost, to empower decision-making on treatment.

Separating value and cost

Lowell Schnipper, Chair of ASCO’s Value in Cancer Care Task Force, said it “critical” to distinguish between value and cost. “Sometimes the more valuable treatment will be the more expensive one and sometimes it won’t be. Ultimately, the definition of ‘value’ will be highly personalised for each patient, taking into account an individual’s own preferences and circumstances,” he noted.

Ultimately, ASCO plans to use the framework as the basis of physician-guided tools for use in clinical settings. But it also stressed that the tool should not be seen as a means to limit patient choice. “This framework is about weighing the options, not limiting them,” said ASCO President Julie Vose. “It should not be used to replace physician judgment or patient preference.”