NCCN cancer treatment costings

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As options for cancer patients become increasingly complicated, and expensive, the most influential source for US oncology treatment guidelines will for the first time offer a tool to assess the costs versus benefits of available therapies, reports Reuters Health.

The National Comprehensive Cancer Network (NCCN) says its new tool will provide a clearer picture of the relative value of medication options, particularly in cases where a very expensive therapy does little to improve survival. Doctors developing the measures expect them to shift demand away from less effective treatments, influencing the prices drug makers are able to charge. They say they are responding to the needs of patients who are having to pay much more for their own care, with higher health insurance premiums, co-payments and deductibles, and want to know the value of their treatments.

The NCCN, an alliance of 26 cancer centres in the US, envisions the new tool as a supplement to its widely followed guidelines for oncology care, which set out protocols for treating a range of cancers based on diagnosis, disease stage and other factors, such as age.

Other medical groups are also trying to address the cost issue, but not as directly as the NCCN. The American Society of Clinical Oncology (ASCO) is developing its own tool for valuing treatments, but says that its "net health benefit" scores will not consider costs, although prices will be noted alongside the scores. In June, New York's Memorial Sloan Kettering Cancer Centre launched an interactive calculator, called "DrugAbacus," that allows users to decide how much one of 54 newer drugs should cost based on factors like side effects and novelty.

The NCCN scale, to be launched in mid-October, will employ "evidence blocks" that assign a score of up to five points for each of five measures – price, effectiveness, safety, quality and consistency of clinical data. Initially, it will evaluate drugs used for multiple myeloma and chronic myeloid leukaemia. Similar guidelines are expected for most other types of cancer by the end of 2016.

"A company that has an effective drug that's appropriately priced should welcome these blocks," said Dr Robert Carlson, NCCN's CEO. If a drug is overpriced, "that's very important information for everybody."

The NCCN says the assessment of each medication will be presented in a simple, tabular form – with each of the five components colored in to represent a score of one to five. The information will appear on its website and in printed literature. Eventually, the comparison tool will be incorporated into healthcare technology systems used by hospitals, including products from IBM Watson and McKesson.

The NCCN website has some 700,000 registered users, and more than 6m copies of its guidelines were downloaded last year. But the current guidelines don't analyze costs, and top oncologists have questioned whether some treatments are worth the price.

Dr Derek Raghavan, president of Levine Cancer Institute at Carolinas HealthCare System, says doctors need much more real-world information at their disposal, including a cost-benefit analysis of side effects. "If Drug B costs 70% of Drug A, but has a side effect profile that brings every second patient to the hospital for a four-day admission, then it does not have value," he said.

Full Reuters Health report NCCN guidelines

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