Novel elements of value in the context of oncology.

Abstract

e18823 Background: Over the past decade, perhaps no single area of the health sector has seen as much groundbreaking innovation as pharmaceuticals. This has been especially true in oncology, where promising curative treatments have been initially celebrated by the media only for access and cost challenges to limit their impact. A narrative has emerged that many of these breakthroughs are not priced according to the value they provide. This thinking has been reinforced by traditional approaches to cost-effectiveness analysis (CEA) that fail to incorporate critically relevant dimensions of value for innovative oncology therapies. What might a broader conception of value in oncology look like? To answer that question, this study reviews oncology-specific considerations when assessing elements of value. Methods: We first review the background on the nature and development of quality-adjusted life years (QALYs) as a part of cost-effectiveness analyses and some of their key limitations. This is followed by a review of “novel” elements of value, which capture specific aspects of patient and societal preferences not included in QALYs, and their applicability to oncology, including discussion on areas where further thought and research might be needed. We conclude with a potential checklist of novel elements of value that should be considered when designing value assessment strategies for products in oncology. Results: Key novel value elements not captured in QALYs under traditional CEA that can be relevant for oncology include value of hope (for a cure), value of insurance (reducing health and financial risk), value of treating very severe diseases, and, real option value (for treatments extending survival enough to allow the option of future cures). The novel value elements of reduced diagnostic uncertainty and the value of knowing are also directly relevant for oncology products with companion diagnostics. Other relevant novel value elements within the context of oncology include scientific spillovers and equity. Few studies have measured these value elements with applications in oncology. Conclusions: Our key takeaways include: (1) since cancer is often a severe disease that is expensive to treat, the potential for novel value elements to be important in economic evaluations of oncology products is high; (2) while some elements of value have been explored in specific economic evaluations, there has been limited adoption of novel elements of value in oncology; (3) the conceptual justification for use of novel value elements in oncology is strong, but standards for their measurement are evolving and further experience with their use would be beneficial; and (4) given the lower prioritization of many of them from the payer perspective, barriers to payer acceptance also seem significant, implying attention must also be paid to establishing the relevance of those elements to payer decision-making.