Balancing Longevity, Quality, and Cost in Oncology Care

At an Institute for Value-Based Care event, cohosted by The American Journal of Managed Care^®(AJMC^®) and Minnesota Oncology, experts gathered to discuss the business side of oncology. Considering talks that explored balancing cost alongside care quality and patient outcomes, Kirollos Hanna, PharmD, BCPS, BCOP, FACCC, director of pharmacy at Minnesota Oncology, sat down with AJMC to further elaborate on the implications that patient longevity—particularly in the wake of advancing treatments—has for oncology care approaches.

This transcript has been lightly edited for clarity.

Transcript

The good news is that improvements in treatments mean patients are living longer. How does that longevity alter how providers are caring for patients?

This is an excellent question. You know, I think when we look at cancer care therapy and we know that patients are certainly living longer, we know that we have a lot of opportunities to help manage and treat our patients. This was a question that came up on the panel discussion between. Doctor Soefje and Dr. Jenson at our AJMC program. And 1 of those questions was around, for example, accelerated approvals of drugs and the other side of it too is, at what point in the patients journey do you start to consider further or additional treatment for potentially a very small window of benefit, an additional week or an additional month of response, vs palliative care, supportive care and those kinds of things. And that's always going to be a challenge, right, because you can't really put a cost on outcomes for patients, right?

And they brought up a really good point on the panel interview. When you look at the United States market and you look at the history of oncolytics that have been approved over the past decade, many of them have been under the FDA's accelerated drug approval program. But about 80% of them actually ended up with the confirmatory approval. So, the phase 3 trials demonstrated the benefit; about 20% had a withdrawn approval and maybe later came back to market or never came back to market, or had some type of orphan indication or something like that. So, when we look at that, we invested a lot of care in managing those patients. But then if there's a withdrawal, you start to question: what about that cost investment, that insurer money and CMS money that went into that?

So, a really interesting concept came up. If a manufacturer has an accelerated drug approval, should they be limited on how much they can charge for the drug until the drug actually gets a confirmatory approval? And then you charge what you want, or what you would have charged. That was a really interesting discussion as you try to help control and contain costs in terms of a value deliverable. But then also on that other side, how do we have shared decision making when we know our patients are multiple lines of therapy in, and when we're evaluating the resources for our patients? And it was really determined that you do need to have a holistic approach, set realistic expectations and really start to determine at what point do you make the decision for that patient to potentially provide supportive cares till end of life vs further lines of therapy that may not have a confirmatory trial that demonstrated a true efficacy and it might be just be based on a marginal difference in response rate. So, it's always going to be this. This evaluation is the glass, you know, half empty, half full, as we're navigating that.