A Touchy Subject: Can Physicians Improve Value by Discussing Costs and Clinical Benefits With Patients?

Wollins, Dana S.; Zafar, S. Yousuf

doi:10.1634/theoncologist.2016-0207

Cited by 12 publications

(5 citation statements)

References 37 publications

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“…The Institute of Medicine and the American Society of Clinical Oncology have highlighted the important role of oncologists in discussions about the OOP costs of cancer care (44,45). Although oncologists generally agree about their responsibility for these discussions (46), they are rare (46) and many oncologists feel uncomfortable engaging in them (46,47). When asked about their attitudes regarding discussions of costs, more than 50% of patients desired discussions, but only about 33% actually had them (46).…”

Section: Provider and Care Team Risk Factors For Medical Financial Hamentioning

confidence: 99%

Medical Financial Hardship among Cancer Survivors in the United States: What Do We Know? What Do We Need to Know?

Yabroff

Zhao

Zheng

et al. 2018

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Rising costs of cancer care have led to increased concerns about medical financial hardship for cancer survivors and their families in the United States. In this commentary, we provide an overview of research describing medical financial hardship and introduce a conceptual framework for identifying risk factors and research gaps at the patient and family, provider and care team, health care system, employer, and state and national policy levels. We then use this framework to highlight measurement and data infrastructure gaps related to hardship, summarize existing interventions to minimize hardship, and identify opportunities for future intervention efforts.

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Section: Provider and Care Team Risk Factors For Medical Financial Hamentioning

confidence: 99%

Medical Financial Hardship among Cancer Survivors in the United States: What Do We Know? What Do We Need to Know?

Yabroff

Zhao

Zheng

et al. 2018

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…The Institute of Medicine later identified these discussions as an element of high-quality care (22), and cost consciousness has been proposed as a core competency for medical education (23). Although oncologists generally agree about their responsibility for cost discussions (24), these discussions are rare (24,25). Nevertheless, most cancer patients desire discussions about expected out-of-pocket costs (24), highlighting an unmet need for informed treatment decision making in cancer care.…”

mentioning

confidence: 99%

Factors Associated With Oncologist Discussions of the Costs of Genomic Testing and Related Treatments

Yabroff

Zhao

Moor³

et al. 2019

JNCI: Journal of the National Cancer Institute

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Background Use of genomic testing is increasing in the United States. Testing can be expensive, and not all tests and related treatments are covered by health insurance. Little is known about how often oncologists discuss costs of testing and treatment or about the factors associated with those discussions. Methods We identified 1220 oncologists who reported discussing genomic testing with their cancer patients from the 2017 National Survey of Precision Medicine in Cancer Treatment. Multivariable polytomous logistic regression analyses were used to assess associations between oncologist and practice characteristics and the frequency of cost discussions. All statistical tests were two-sided. Results Among oncologists who discussed genomic testing with patients, 50.0% reported often discussing the likely costs of testing and related treatments, 26.3% reported sometimes discussing costs, and 23.7% reported never or rarely discussing costs. In adjusted analyses, oncologists with training in genomic testing or working in practices with electronic medical record alerts for genomic tests were more likely to have cost discussions sometimes (odds ratio [OR] = 2.09, 95% confidence interval [CI] = 1.19 to 3.69) or often (OR = 2.22, 95% CI = 1.30 to 3.79), respectively, compared to rarely or never. Other factors statistically significantly associated with more frequent cost discussions included treating solid tumors (rather than only hematological cancers), using next-generation sequencing gene panel tests, having higher patient volume, and working in practices with higher percentages of patients insured by Medicaid, or self-paid or uninsured. Conclusions Interventions targeting modifiable oncologist and practice factors, such as training in genomic testing and use of electronic medical record alerts, may help improve cost discussions about genomic testing and related treatments.

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“…Individual physicians may have little ability to effect changes such as these, but physician professional organizations may have that ability if sufficient political courage can be mustered. What individual physicians can do is have conversations with their patients about costs that are aimed at helping patients make decisions that better accord with their values [12]. We also suggest that pharmaceutical manufacturers be held responsible for what is justly regarded as price gouging, as illustrated by media coverage of Valeant [13].…”

Section: Trade-offs: Policies For Drug Coverage In the Real Worldmentioning

confidence: 99%

How Should Therapeutic Decisions about Expensive Drugs Be Made in Imperfect Environments?

Fleck

Danis

2017

AMA Journal of Ethics

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Clinicians must inevitably make therapeutic decisions under nonideal conditions. They practice in circumstances that involve incomplete evidence. They deliver care in health care systems that are complex and poorly coordinated. Each of the patients that they take care of is unique while research offers evidence regarding relatively homogeneous populations of patients. Under these circumstances, many partiesmedical scientists, reviewing agencies, insurers, and accountable care organizations-can and should contribute to optimizing the development, approval, funding, and prescription of therapiesparticularly expensive and marginally beneficial therapies. In aggregate, they should aspire to achieve a pattern of fair, cost-effective therapeutic decisions to ensure a sustainable health care system. Here we offer some suggestions regarding decisions that physicians might pursue to facilitate fair and cost-effective patient care. CaseDr. C sits on a committee as part of his tertiary care center's accountable care organization (ACO) that is considering whether a new biologic, Expensivimab, should be included in the organization's bundled treatment plan for its patients. Expensivimab is a new humanized antibody that targets an apoptotic receptor. One study suggests that it increases tumor-free survival in late stage non-small cell lung cancer (NSCLC) by a median of six months relative to a drug approved several years ago. Another suggests that it increases overall survival by a month-and-a half relative to the same drug. Yet no research on the comparative effectiveness of Expensivimab relative to other interventions for NSCLC exists, and even data on the risks of Expensivimab relative to the older drug is scant.Furthermore, assessing Expensivimab's cost-benefit ratio is difficult. Although Expensivimab costs $750,000 per patient, the United States Food and Drug Administration (FDA) did not request any data on trial participants' perceptions of their quality of life. Hence, no assessment of quality-adjusted life years (QALYs) or disability-

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A Touchy Subject: Can Physicians Improve Value by Discussing Costs and Clinical Benefits With Patients?

Cited by 12 publications

References 37 publications

Medical Financial Hardship among Cancer Survivors in the United States: What Do We Know? What Do We Need to Know?

Medical Financial Hardship among Cancer Survivors in the United States: What Do We Know? What Do We Need to Know?

Factors Associated With Oncologist Discussions of the Costs of Genomic Testing and Related Treatments

How Should Therapeutic Decisions about Expensive Drugs Be Made in Imperfect Environments?

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