Denduluri: Yes. We are looking at many aspects of this important issue, such as trying to measure the relationship between proper drug
utilization and patient quality of life. Since this is a physician-driven effort, we recognize that costs have to be evaluated
in a broader context that gives credence to when a patient is able to carry out normal functions and maintain the lifestyle
to which he or she is accustomed.
Don Creighton, PriceSpective
Don Creighton, PriceSpective: I believe the drug industry would be supportive of building clear metrics around the linkage between the cost and effectiveness
of treatments, as payers and health technology agencies are interpreting this relationship to render important judgments about
market access. Right now, decisions are being made that make companies very anxious about whether approved treatments will
actually be obtainable by patients in the clinical setting.
Stein: The larger issue here is reconciling the concept of a practice guideline —which by definition relies on a population-based
metric—with the move toward individualized treatment, now being facilitated by the progress in understanding genetic variations
in tumor growth and in the application of diagnostics. It's a dichotomy we struggle with throughout the compound development
process; payers too are trying to find the right way to be fair in deciding what treatments are reimbursed.
Fitzgerald: NCCN Guidelines must tackle this dichotomy if they are to maintain status as the standard of care in oncology. We have just
launched a biomarker compendium and, as the technology and understanding of tumor heterogeneity advances, our NCCN Guidelines
will need to incorporate this evidence. There is no choice: the market dictates. When the NCCN compendium was formally recognized
in 2008 by United Healthcare and CMS, coverage decisions for millions of patients were now driven by the compendium. Today,
however, insurers are contracting separately with multiple for-profit pathway companies that have the effect of limiting provider
choices in applying our guidelines. This is one reason why NCCN is contracting with McKesson on the Value Pathways Powered
by NCCN and the decision assist tool based on the NCCN Guidelines. The fact that it is devised and managed directly by physicians
for physicians gives the profession an alternative to just accepting what the payers are putting forward.