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Guideline
, 33 (23), 2563-77

American Society of Clinical Oncology Statement: A Conceptual Framework to Assess the Value of Cancer Treatment Options

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Guideline

American Society of Clinical Oncology Statement: A Conceptual Framework to Assess the Value of Cancer Treatment Options

Lowell E Schnipper et al. J Clin Oncol.

Conflict of interest statement

Authors' disclosures of potential conflicts of interest are found in the article online at www.jco.org. Author contributions are found at the end of this article.

Figures

Fig 1.
Fig 1.
ASCO Value Framework: advanced disease. Future versions of the framework will allow for patients weighting their preferences such that the fractional contribution of each element (clinical benefit, toxicity) to the overall score can be modified, thereby individualizing the net health benefit. ASCO, American Society of Clinical Oncology; CR, complete response; DAC, drug acquisition cost; OS, overall survival; PFS, progression-free survival; PR, partial response; RR, response rate.
Fig 2.
Fig 2.
ASCO Value Framework: adjuvant setting. Future versions of the framework will allow for patients weighting their preferences such that the fractional contribution of each element (clinical benefit, toxicity) can be modified, thereby individualizing the net health benefit. ASCO, American Society of Clinical Oncology; DAC, drug acquisition cost; DFS, disease-free survival; HR, hazard ratio.
Fig 3.
Fig 3.
Clinical benefit, toxicity, net health benefit (NHB), and cost of four regimens when compared with standard-of-care regimen used in clinical trials for first-line treatment of metastatic non–small-cell lung cancer: (A) bevacizumab, paclitaxel, and carboplatin versus carboplatin plus paclitaxel (control); (B) cisplatin plus pemetrexed versus cisplatin plus gemcitabine (control); (C) docetaxel plus gemcitabine versus docetaxel plus cisplatin (control); and (D) erlotinib versus cisplatin plus docetaxel or cisplatin plus gemcitabine (control) in patients with EGFR mutation–positive advanced NSCLC. Raw data for each parameter shown above each bar. Costs based on average sales price as of October 2014 for intravenous therapies and on information from UnitedHealthcare for oral drugs; shown per month of treatment. Table 2 summarizes information shown in figure. Similar data can be found in Appendix Tables A1 to A15 (online only). (A) Bevacizumab, paclitaxel, and carboplatin has overall survival (OS) of 12.3 months versus 10.3-month OS for carboplatin plus paclitaxel (control), 15 grade 3 to 5 toxicities versus 22 for control, NHB of 16 of maximum 130, and cost of $11,907.87 per month versus $182.09 per month for control. (B) Cisplatin plus pemetrexed has OS of 10.3 months versus 10.3-month OS for cisplatin plus gemcitabine (control), 10 grade 3 to 5 toxicities versus 10 for control, NHB of zero of maximum 130, and cost of $9,193.07 per month versus $811.72 per month for control. (C) Docetaxel plus gemcitabine has OS of 9.5 months versus 10.0-month OS for docetaxel plus cisplatin (control), 13 grade 3 to 5 toxicities versus 15 for control, NHB of zero of maximum 130, and cost of $2,184.18 per month versus $2,019.80 per month for control. (D) Oral erlotinib has median progression-free survival (PFS) of 9.7 months versus 5.2 months for cisplatin plus docetaxel or cisplatin plus gemcitabine (control), eight grade 3 to 5 toxicities versus 12 for control, NHB of 44 of maximum 130, and cost of $4,607.63 per month versus $1,686.99 per month for cisplatin plus docetaxel and $903.31 per month for cisplatin plus gemcitabine.
Fig 4.
Fig 4.
Clinical benefit, toxicity, net health benefit (NHB), and cost of bortezomib, melphalan, and prednisone when compared with melphalan plus prednisone (control) in clinical trial for first-line treatment of advanced multiple myeloma., Bortezomib, melphalan, and prednisone has overall survival (OS) of 56.4 months versus 43.1-month OS for melphalan plus prednisone (control), 42 grade 3 to 5 toxicities versus 34 for control, NHB of 47 of maximum 130, and cost of $7,042.70 per month versus $279.45 per month for control. Raw data for each parameter shown above each bar. Costs based on average sales price as of October 2014 for intravenous therapies and on information from UnitedHealthcare for oral drugs; shown per month of treatment.
Fig 5.
Fig 5.
Clinical benefit, toxicity, net health benefit (NHB), and cost of three regimens when compared with standard-of-care regimen used in clinical trial for first-line treatment of metastatic castration-resistant prostate cancer: (A) abiraterone plus prednisone versus placebo (control),, (B) cabazitaxel plus prednisone versus mitoxantrone plus prednisone (control), and (C) enzalutamide versus placebo (control). Raw data for each parameter shown above each bar. Costs based on average sales price as of October 2014 for intravenous therapies and on information from UnitedHealthcare for oral drugs; shown per month of treatment. (A) Abiraterone plus prednisone has overall survival (OS) of 14.8 months versus 10.9-month OS for placebo (control), 37 grade 3 to 5 toxicities versus 34 for control, NHB of 42 of maximum 130, and cost of $7,523.88 per month versus $0 per month for control. (B) Cabazitaxel plus prednisone has OS of 15.1 months versus 12.7-month OS for mitoxantrone plus prednisone (control), 21 grade 3 to 5 toxicities versus 19 for control, NHB of 16 of maximum 130, and cost of $10,699.43 per month versus $245.14 per month for control. (C) Enzalutamide has overall survival (OS) of 18.4 months versus 13.6-month OS for placebo (control), eight grade 3 to 5 toxicities versus six for control, NHB of 32 of maximum 130, and cost of $8,494.91 per month versus $0 per month for control.
Fig 6.
Fig 6.
Clinical benefit, toxicity, net health benefit (NHB), and cost of two regimens when compared with standard-of-care regimen used in clinical trial for adjuvant treatment of human epidermal growth factor receptor 2–positive breast cancer: (A) doxorubicin plus cyclophosphamide followed by paclitaxel plus trastuzumab and total of 1 year of trastuzumab versus doxorubicin, cyclophosphamide, and paclitaxel (control), and (B) docetaxel, carboplatin, and trastuzumab followed by total of 1 year of trastuzumab versus doxorubicin, cyclophosphamide, and docetaxel (control). Raw data for each parameter shown above each bar. Costs based on average sales price as of October 2014 for intravenous therapies and on information from UnitedHealthcare for oral drugs; shown as cost of delivering entire course of regimen. (A) Doxorubicin, cyclophosphamide, and paclitaxel plus trastuzumab versus doxorubicin, cyclophosphamide, and paclitaxel (control) has hazard ratio (HR) of 0.61, or 39% reduction in risk of death, when compared with control, three grade 3 to 5 toxicities versus three for control; NHB of 48 of maximum 100, and cost of $73,165.62 versus $3,405.02 for control. (B) Docetaxel, carboplatin, and trastuzumab versus doxorubicin, cyclophosphamide, and docetaxel (control) has HR of 0.77, or 23% reduction in risk of death, when compared with control, 20 grade 3 to 5 toxicities versus 20 for control, NHB of 32 of maximum 100, and cost of $65,707.59 versus $7,052.94 for control.
Fig 7.
Fig 7.
Clinical benefit, toxicity, net health benefit (NHB), and cost using cisplatin/pemetrexed versus cisplatin/gemcitabine (control) for first-line treatment of metastatic non–small-cell lung cancer in patients with nonsquamous histology. Raw data for each parameter are shown above each bar. Cost is based on average sales price as of October 2014 for intravenous therapies and on information from UnitedHealthcare for oral drugs; shown per month of treatment. Table 3 summarizes information shown in the figure. Cisplatin/pemetrexed has an overall survival (OS) of 11.8 months versus 10.4 months for cisplatin/gemcitabine (control), 10 grade 3 to 5 toxicities versus 10 for control, NHB of 16 of a maximum of 130, and cost of $9,193.07/month versus $811.72/month for control.

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