18 research outputs found
The Importance of Economic Perspective and Quantitative Approaches in Oncology Value Frameworks of Drug Selection and Shared Decision Making
The debate around value in oncology drug selection has been prominent in
recent years, and several professional bodies have furthered this debate
by advocating for so-called value frameworks. Herein, we provide a viewpoint
on these value frameworks, emphasizing the need to consider 4 key
aspects: (1) the economic underpinnings of value; (2) the importance of
the perspective adopted in the valuation; (3) the importance of the difference
between absolute and relative measures of risk and measuring
patient preferences; and (4) the recognition of multiple quality-of-life (QoL)
domains, and the aggregation and valuation of those domains, through
utilities within a multicriteria decision analysis, may allow prioritization of
QoL above the tallying of safety events, particularly in a value framework
focusing on the individual patient.
While several frameworks exist, they incorporate different attributes
and—importantly—assess value from alternative perspectives, including
those of patients, regulators, payers, and society. The various perspectives
necessarily lead to potentially different, if not sometimes divergent, conclusions
about the valuation. We show that the perspective of the valuation
affects the framing of the risk/benefit question and the methodology to
measure the individual patient choice, or preference, as opposed to the
collective, or population, choice.
We focus specifically on the American Society of Clinical Oncology
(ASCO) Value Framework. We argue that its laudable intent to assist in
shared clinician-patient decision making can be augmented by more formally
adopting methodology underpinned by micro- and health economic
concepts, as well as application of formal quantitative approaches. Our recommendations
for value frameworks focusing on the individual patient, such
as the ASCO Value Framework, are 3-fold: (1) ensure that stakeholders
understand the importance of the adopted (economic) perspective; (2)
consider using exclusively absolute measures of risk and formal patientpreference
methodology; and (3) consider foregoing safety parameters for
higher-order utility considerations
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