Toward a Patient-Centered Value Framework in Oncology

Abstract

Cancer drugs are toxic and expensive. Their benefits are often difficult to measure, vary substantially between patients, and too often are quite modest in improving outcomes. Multiple approaches have been developed recently to quantify and combine these treatment characteristics (harms, costs, and benefits) into composite “value” metrics that enable crosstreatment comparisons, formulary prioritization, and assessments of whether pricing is reasonable. In their Viewpoint in this issue of JAMA, Chandra and colleagues1 compare 5 such frameworks for assessing the value of cancer drugs: the American Society of Clinical Oncology “Value Framework” (ASCO)2; the European Society for Medical Oncology “Magnitude of Clinical Benefit Scale” (ESMO)3; the Institute for Clinical and Economic Review “Value Assessment Framework” (ICER)4; the Memorial Sloan Kettering Cancer Center “Drug Abacus” (MSK)5; and the National Comprehensive Cancer Network “Evidence Blocks” (NCCN)