PCN225 LOW VALUE CARE IN ONCOLOGY: US ONCOLOGISTS’ PERCEPTIONS

Abstract

Value-based care (VBC) delivery can be enhanced by use of available evidence-based tools (EBTs) e.g., NCCN evidence blocks (NEB), ASCO value framework (AVF) and Drug Abacus. We sought to understand the utilization of EBTs and evaluate the perceptions of oncologists regarding low-value oncology care. A November 2019 live meeting convened a representative sample of US community-based hematologists/oncologists (cH/O) for a discussion entitled “Low-Value Care- Operationalizing Value”; responses were captured via an audience response system. Of the 54 oncologists, 33% and 30% participated in ASCO QOPI (Quality Oncology Practice Initiative) and OCM (Oncology Care Model) respectively. EBTs use: 50% none, 46% NEB, 17% AVF; 54% were unaware of the metric, quality-adjusted life years (QALY) gained minimal threshold of $150,000, for cost effectiveness with 11% identifying it accurately. Barriers to EBTs utilization included the perception that oncologists should not have to assess the cost when an agent is used in an approved indication (50%) and that EBTs use is a time-consuming process (48%). 64% supported the notion that the FDA should take cost-effectiveness into account before approving drugs for use. Importance ranking of measures to reduce low-value care: Limiting aggressive therapy at end of life (EoL) (65%), limiting use of expensive medications with limited efficacy (54%) and reducing hospitalizations (48%). Measures actually employed to improve VBC: Decreased chemotherapy at EoL (56%), increased utilization of patient navigators (33%) and follow-up calls post-therapy to assess for adverse events (32%). EBTs were used by a minority of cH/O who prefer to focus on timely transition to palliative care, limiting use of drugs with low efficacy, and reducing hospitalizations as major VBC initiatives. We observed a discordance between the most effective VBC measures and those employed by their practices. The majority cH/O believe drug cost should be considered in FDA drug approval.