Value-based medicine in oncology: the importance of perspective in the emerging value frameworks

Clinics (Sao Paulo). 2018 Dec 10;73(suppl 1):e470s. doi: 10.6061/clinics/2018/e470s.

Abstract

Recently, professional and healthcare-related entities have launched frameworks designed to assess the value of cancer innovations in multistakeholder decision processes. Among the most visible entities that propose and implement value frameworks in oncology are the European Society of Medical Oncology (ESMO), the American Society of Clinical Oncology (ASCO), the Memorial Sloan Kettering Cancer Center (MSKCC) and the National Comprehensive Cancer Network (NCCN). However, these value frameworks have been criticized for conceptual inconsistencies, inability to include a greater variety of value criteria, and inadequate explanation of the uncertainty approach used in the modeling process. On the other hand, Multi-Criteria Decision Analysis (MCDA) is a set of methods and processes that allow the multiple criteria involved in a decision to be explicitly addressed. This approach allows the identification of relevant decision criteria, gathering of evidence based on scientific literature, attribution of weights to the criteria and scores to the evidence raised, and aggregation of the weighted scores to constitute a global metric of value. The purpose of this article is to review the main features of these value frameworks in oncology and the importance of perspective for framework readiness to support healthcare decision-making based on MCDA methodology.

Publication types

  • Review

MeSH terms

  • Clinical Decision-Making / methods*
  • Cost-Benefit Analysis
  • Decision Support Systems, Clinical / economics
  • Decision Support Systems, Clinical / standards*
  • Delivery of Health Care / economics
  • Delivery of Health Care / standards
  • Humans
  • Medical Oncology / economics
  • Medical Oncology / standards*
  • Reference Standards