Value-based medicine in oncology: the importance of perspective in the emerging value frameworks

Abstract

Recently, professional and healthcare-related entities have launched frameworks designed to assess the value of cancer innovations in multistakeholder decision processes. Among the most visible entities that propose and implement value frameworks in oncology are the European Society of Medical Oncology (ESMO), the American Society of Clinical Oncology (ASCO), the Memorial Sloan Kettering Cancer Center (MSKCC) and the National Comprehensive Cancer Network (NCCN). However, these value frameworks have been criticized for conceptual inconsistencies, inability to include a greater variety of value criteria, and inadequate explanation of the uncertainty approach used in the modeling process. On the other hand, Multi-Criteria Decision Analysis (MCDA) is a set of methods and processes that allow the multiple criteria involved in a decision to be explicitly addressed. This approach allows the identification of relevant decision criteria, gathering of evidence based on scientific literature, attribution of weights to the criteria and scores to the evidence raised, and aggregation of the weighted scores to constitute a global metric of value. The purpose of this article is to review the main features of these value frameworks in oncology and the importance of perspective for framework readiness to support healthcare decision-making based on MCDA methodology.

Development of a Multicriteria Decision Analysis Framework for Evaluating and Positioning Oncologic Treatments in Clinical Practice

“…In addition, MCDA can improve stakeholder participation and facilitate conflict mediation. 16 Some authors consider that limiting the coverage and use of drugs with a modest impact on survival could persuade pharmaceutical companies to direct efforts into developing drugs with truly meaningful survival benefits. 38 In this context, rethinking how the value of a drug is defined would play an important role in driving future drug development.…”

“…Outputs vary among frameworks, including how the health benefit is defined and if they consider the drug cost relative to absolute value, and the cost to patients and health care systems. 15,16 A comparison of ESMO and ASCO frameworks applied to clinical trials showed that they differed in their measurement of clinical benefit and that the convergence of criteria was weak to moderate 17 ; however, a more recent study showed a higher level of agreement and no convergence in the approaches used to evaluate relative and absolute gain for overall and progression-free survival, and toxicity, among others. 18 The NCCN framework covers similar aspects, but the criteria are less well defined, whereas the ICER framework provides an economic analysis of a drug in the health care system.…”

“…7 Literature on developed frameworks and their comparison was also reviewed. [15][16][17][18]24,25 Criteria Assessment and Development of the Framework On the basis of the literature review and following EVIDEM methodology, 15 criteria were selected to create the MCDA framework. These criteria were divided into 5 main categories: disease needs, comparative results of the drug, type of benefit of the drug, economic consequences of the drug, and knowledge about the drug.…”

Value-based health care – what does it mean for radiotherapy?

“…The ESMO Magnitude of Clinical Benefit Scale, ASCO Value Framework and NCCN Blocks have been extensively discussed concerning their development, methodologies used and results generated. Although it has been argued that these frameworks vary in value assessment of specific drugs and do not truly capture value to support population-level decision-making, their merit lies in proposing strict methodologies evaluating outcome, all or not in combination with costs, and in putting value on the international oncology agenda [7,[45][46][47][48].…”

Value Frameworks: Adaptation of Korean Versions of Value Frameworks for Oncology

“…The ASCO-NHB and ESMO-MCBS have been widely used in corresponding jurisdictions, but it is not known whether these tools can be used in the context of other countries [ 12 , 13 ]. No previous studies have evaluated the validity of adaptations or translations of these two tools into their own language.…”