[PRM15] The American Society of Clinical Oncology (Asco) Net Health Benefit (Nhb) Assessment Tool: Which Implications for Value Assessment of Cancer Therapies?

[PRM15] The American Society of Clinical Oncology (Asco) Net Health Benefit (Nhb) Assessment Tool: Which Implications for Value Assessment of Cancer Therapies?

2016 ISPOR 19th Annual European Congress

Rémuzat, C. | Chouaid, C. | Auquier, P. | Borget, I. | Kornfeld, M. | Toumi, M. | Volume: 19, Issue: 7, Pages: A359-A360,

OBJECTIVES: Financial toxicity concept was recently introduced in the United States related to financial distress resulting from out-of-pocket payments of costly cancer medicines. In 2015, ASCO developed a framework to support physicians and patients in assessing value of new cancer therapies and to facilitate dialogue between physicians and patients. This research aimed to review the tool and identify its contributions and limits for fair decisions. METHODS: ASCO value framework was reviewed to identify dimensions taken into account and its contribution for patients and physicians’ shared-decision making. RESULTS: ASCO value framework is built to compare new cancer therapies versus standard of care using data from prospective randomised trials and includes 2 sub-frameworks: one for advanced and one for early stage cancers; both of them include 2 main dimensions: clinical benefit (overall survival (OS), progression-free survival (PFS), response rate (RR), disease-free survival (DFS) depending on available data), and toxicity computed in net health benefit (NHB). Maximum scoring for clinical benefit is 100 (more important weight on OS versus PFS or RR), while being 20 for toxicity. Bonus points are awarded for tail of the survival curve (20 points); advance disease framework also includes palliation of symptoms (10 points) and/or treatment-free interval (20 points) and/or quality of life (QoL) (10 points). Initially, QoL was deliberately not included in the framework, reflecting the lack of QoL data in many clinical trials. Drug acquisition costs and patient out-of-pocket payment are also considered but not included in NHB. CONCLUSIONS: ASCO value framework represents clear improvement in supporting physicians’ and patient’s decisions for cancer therapies. It reflects more physicians’ perspective while clinical benefits are over rated versus toxicity and only 10 bonus points awarded for QoL, which may have more importance for patients. However, this tool is continuously evolving through feedback of various stakeholders with strong willingness to improve patient’s empowerment.

https://www.doi.org/10.1016/j.jval.2016.09.078