NCCN Strives to Control Cost of Cancer Drugs With New Evaluation Framework

Tony Hagen @oncobiz
Published: Tuesday, Aug 25, 2015
Robert Carlson, MD, CEO of the NCCN

Robert Carlson, MD

Key Takeaways
  • NCCN Guidelines for Chronic Myelogenous Leukemia and Multiple Myeloma will be the first to incorporate cost elements.
  • The NCCN also plans to incorporate cost into the existing NCCN Chemotherapy Order Templates.
  • The payer Anthem says drug valuation tools fall short of need, but are an “extremely positive step.”
  • ASCO’s drug valuation tool will supplement the CancerLinQ patient information portal to more broadly inform treatment decisions.
As cancer drugs soar in price, the National Comprehensive Cancer Network (NCCN) is introducing cost as a measure of the overall value of a therapy, following the trail of ASCO and a doctor from Memorial Sloan Kettering Cancer Center in attempting to put a lid on drug inflation.

The NCCN plans to introduce price guidelines for oncologists and patients this year. “What we’ve heard from multiple payers is that they want to be able to identify therapies that have equivalent benefits and equivalent toxicities, but also lower cost, in order to do a better job of cost control and cost containment,” says Robert Carlson, MD, CEO of the NCCN.

The NCCN is building financial information into the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines), starting with the NCCN Guidelines for Chronic Myelogenous Leukemia and Multiple Myeloma. The cost component will be a part of the NCCN Evidence Blocks, slated for publication in October 2015. Cost of a particular medicine is not integral to a recommendation for a particular regimen, but it is provided along with other data to help with the choice of treatments, Carlson says.

“It’s more about providing information regarding cost, rather than necessarily restricting choice based upon cost,” he told Oncology Business Management in an interview.

NCCN Guidelines Will Soon Incorporate Cost Considerations

The NCCN Evidence Blocks, which provide a number of measures by which to evaluate a therapy choice: efficacy, safety, quality of evidence supporting the recommended therapy, consistency of evidence supporting the recommended therapy, and affordability. All of this information is presented in the form of a graphic for ease of use and understanding.

“Each of those measures is scored on a scale of 1 to 5. The block is shaded in with color to correspond to whatever the value is for that specific dimension. It allows a user to look at a number of different options and very, very efficiently scan the document to get a sense of how a specific recommendation or group of recommendations fulfills all of those different metrics,” Carlson says.

Carlson says the NCCN did it this way because they believe that using a formula to decide which drugs to use is not as helpful for patients and doctors. “Circumstances vary; how patients value different things or issues varies.” For some patients, toxicity is the primary concern, whereas for others, efficacy or cost may be the key consideration. The evidence block can serve as a starter for a productive conversation between physician and patient about which course of treatment to follow, while also empowering the patient to take a more active role, Carlson says.

“Our system is simple,” Carlson says. “It’s intuitive, it’s graphic—so we think it can be processed very quickly. It’s designed to provide information to physicians and patients so that they can figure out what their own formula is in terms of weighting the different components that people use to make decisions.”

The NCCN also plans to incorporate cost into the existing NCCN Chemotherapy Order Templates (NCCN Templates), which assist physicians in ensuring that they are administering the latest evidence-based chemotherapy regimens for their patients in a safe and consistent manner. The NCCN Templates include chemotherapy, immunotherapy, supportive care agents, monitoring parameters, and safety instructions for therapies included in the NCCN Guidelines. Now, the NCCN is planning to add the cost of chemotherapy regimens and required or recommended supportive care to those regimens, Carlson says.

Intravenous or intramuscular medications are calculated based on average sales price, whereas oral drug costs are taken from the Humana Medicare database. “That information is simply a dollar cost that will be put on that chemotherapy template document,” he says.

Anthem Responds to ASCO’s Drug Valuation Methodology

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