Editor’s Note: As we went to press with this article, NCCN was just unveiling their first NCCN Evidence Blocks™ for Chronic Myelogenous Leukemia (CML) and Multiple Myeloma (MM) at a press conference on Oct. 16 in San Francisco. OBR will keep you updated on NCCN's new value initiative with daily news and feature articles throughout 2015 and into 2016.
As prices for cancer therapies continue to rise, the value offered by a treatment is coming under increasing scrutiny, and professional organizations are responding by including value in their assessments of treatments. Historically, the National Comprehensive Cancer Network (NCCN) has asked its panels not to consider cost when assembling NCCN guidelines; nonetheless the national organization has added the new measure of affordability in their new Evidence Blocks, which are rolling out in October.
Cancer drug prices have escalated by an average of $8,500 a year over the last 15 years, from a cost of each additional year lived of $54,000 in 1995 to a whopping $207,000 in 2013, after adjusting for inflation.1 The median price of a month of therapy is currently running about $10,000, with the costs of some treatments running over $100,000 for a course of treatment.
As costs for cancer care become increasingly stratospheric, financial toxicity is an increasing concern for patients. Along with NCCN’s Evidence Blocks, ASCO has published their Value Framework, which assesses the value of new cancer therapies based on treatment benefits, toxicities, and costs.2 And, overseas, the European Society for Medical Oncology (ESMO) has also published a scale to evaluate the effectiveness of cancer medicines.3
NCCN Evidence Blocks
The NCCN Evidence Blocks represent NCCN’s efforts to better explain why specific recommendations were made in their guidelines, which shape reimbursement policies for many payers. In an interview, Robert Carlson, MD, CEO of NCCN, explained that they came up with five measures that they thought were important to help explain the rationale for a specific recommendation. The five measures are: efficacy, safety, quality, consistency of data that supports the recommendation, and affordability. (Figure 1.)
He reiterated that NCCN panels are specifically told not to consider cost when they are putting the guidelines together.
“The affordability measure is actually an add-on to the guideline. It did not exist before and is not used for the panel to make specific recommendations,” he said.
NCCN is planning to add the affordability measure to all of their guidelines. First will be systemic therapy, starting with chronic myelogenous leukemia and multiple myeloma, and then drugs and biologic agents. After those parts of the guidelines are populated, NCCN will be expanding to include radiation oncology, surgical oncology, and diagnostic tests.
Dr. Carlson explained that the Evidence Blocks add transparency to NCCN’s decision-making process. “It especially adds transparency for patients. While payers know a great deal about what they’re paying for a treatment and most physicians have a general idea of the cost of a treatment, the patients are the people who are really out of the loop,” he said.