Perceptions of Drug Affordability, Value Frameworks in Oncology


The increasing prevalence of cancer, along with US Food and Drug Administration-approved drugs and technologies, have brought about increased scrutiny to the cost and value of treatments in oncology.

Bijal Shah-Manek, BPharm, PhD, Ipsos Healthcare (San Francisco, CA) and Touro University College of Pharmacy (Vallejo, CA), and colleagues conducted a study (Journal of Managed Care & Specialty Pharmacy; February 2018;16:1-9) to assess oncologists’ perceptions of drug affordability using National Comprehensive Cancer Network (NCCN) Evidence Blocks.

Journal of Clinical Pathways spoke with Dr Shah-Manek to hear more about the study’s findings and the proposed ways to improve value frameworks in oncology.

Can you briefly describe the scope of your study?

Dr Shah-Manek: To address the rising concern about oncology drug costs, several stakeholders have developed frameworks to help assess the value of oncology therapies. Our study sought to assess oncologists’ awareness and knowledge of oncology value frameworks in the United States and to understand their perceptions of affordability in the context of NCCN Evidence Blocks.

What was the inspiration for assessing oncologist perceptions of value frameworks and affordability?

Dr Shah-Manek: Several frameworks have recently emerged to assess the value of treatments from the perspective of patients, payers, providers, and society. We wanted to assess oncologist’s knowledge and opinions of these value frameworks and assess their opinions of affordability. In particular, the NCCN Evidence Blocks is a framework that seeks to assess affordability from a broad health care systems perspective based on the overall cost of the regimen, including cost of drug, administration, supportive care, identification, and management of toxicities and probability of hospitalization. However, the affordability construct is complicated, and we wanted to gauge if US-based community oncologists understand the cost of cancer care.

One of the conclusions that you drew from the study is that while costs associated with affordability were not consistent with actual treatment costs, most oncologists were not comfortable with rating affordability. From where do you think this sentiment is derived?

Dr Shah-Manek: Our study found that only 26% of surveyed oncologists reported that they were comfortable or very comfortable with rating costs associated with affordability levels. Currently, the NCCN Evidence Blocks do not specify the perspective or context for affordability which could lead to variability and subjectivity in the ratings. Further, oncologists are asked to rely on their knowledge of costs to rate affordability and estimate health care system costs that may go beyond costs incurred within their own practice.  

Can you briefly explain your findings regarding patient out-of-pocket costs?

Dr Shah-Manek: The intended use of the NCCN Evidence Blocks is to help physicians and patients discuss value while navigating the treatment decision-making process. Our study found that from an oncologist’s perspective, patient out-of-pocket costs was the most important factor influencing affordability ratings. However, patient out-of-pocket costs are excluded from the NCCN Affordability rating metric. We also observed a potential inconsistency between available data on out-of-pocket costs and perceived out-of-pocket costs. This may warrant further exploration.

Based on your findings, how can value frameworks be improved?

Dr Shah-Manek: Value frameworks can be useful in helping decision makers assess the value of therapies.  Our study takes into account only one perspective: that of the providers. In order to improve value frameworks, it is important to ensure that the perspective of all stakeholders—patients, providers, payers, and society—are adequately accounted for.