Background: Anticancer drug prices have increased by an average of 12% each year from 1996 to 2014. A major concern is that the increasing cost and responsibility of evaluating treatment options are being shifted to patients. This research compared 2 value-based pricing models that were being considered for use at the University of California, San Francisco (UCSF) Medical Center to address the growing burden of high-cost cancer drugs while improving patient-centered care.
Program description: The Medication Outcomes Center (MOC) in the Department of Clinical Pharmacy, University of California, San Francisco (UCSF), School of Pharmacy focuses on assessing the value of medication-related health care interventions and disseminating findings to the UCSF Medical Center. The High Cost Oncology Drug Initiative at the MOC aims to assess and adopt tools for the critical assessment and amelioration of high-cost cancer drugs. The American Society of Clinical Oncology (ASCO) Value Framework (2016 update) and a cost-effectiveness analysis (CEA) framework were identified as potential tools for adoption. To assess 1 prominent value framework, the study investigators (a) asked 8 clinicians to complete the ASCO Value Framework for 11 anticancer medications selected by the MOC; (b) reviewed CEAs assessing the drugs; (c) generated descriptive statistics; and (d) analyzed inter-rater reliability, convergence validity, and ranking consistency.
Observations: On the scale of -20 to 180, the mean ASCO net health benefit (NHB) total score across 11 drugs ranged from 7.6 (SD = 7.8) to 53 (SD = 9.8). The Kappa coefficient (κ) for NHB scores across raters was 0.11, which is categorized as "slightly reliable." The combined κ score was 0.22, which is interpreted as low to fair inter-rater reliability. Convergent validity indicates that the correlation between NHB scores and CEA-based incremental cost-effectiveness ratios (ICERs) was low (-0.215). Ranking of ICERs, ASCO scores, and wholesale acquisition costs indicated different results between frameworks.
Implications: The ASCO Value Framework requires further specificity before use in a clinical setting, since it currently results in low inter-rater reliability and validity. Furthermore, ASCO scores were unable to discriminate between drugs providing the most and least value.
Recommendations: The evaluation provides specific areas of weakness that can be addressed in future updates of the ASCO framework to improve usability. Meanwhile, the UCSF Medical Center should rely on CEAs, which are highly accessible for the highlighted cancer drugs. The MOC role can include summarizing and disseminating available CEA studies for interpretation by clinicians and financial counselors around drug value.
Disclosures: Funding for this research was contributed by the University of California, San Francisco, Medical Center Campus Strategic Initiative Program. The authors have no conflicts of interest to disclose. Study concept and design were contributed primarily by Wilson, along with Wang and Patel. Kim, Dacey, and Yuen collected the data, and data interpretation was performed by Wilson and Lin. The manuscript was written by Wilson, Lin, Wang, and Tran and revised by Lin, Redondi, Brodowy, and Kroon.