Oncology: Pathways to Progress - Pharmaceutical Executive

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Oncology: Pathways to Progress


Pharmaceutical Executive



Don Creighton, PriceSpective
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: 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.


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