Oncology

As U.S. consumers are asked to shoulder more prescription drug costs, drugmakers say prices for brand-name medicines will keep rising, mainly because use of their products reduces other healthcare costs.

Amy Berman, BS, RN, says that all too often, people end up in the hospital because they don't know where else to go for treatment.

In a bid to improve treatment for men with high-risk prostate cancer, some researchers want to take a page from the playbook for breast cancer.

Scott Ramsey, MD, PhD, Fred Hutchinson Cancer Research Center, says that right now, only a small portion of health economics and outcomes research (HEOR) fits into the oncology model.

Effective management of the comorbidities of diabetes and hypertension may increase survival in older breast cancer survivors.

Starting next September, women at increased risk for breast cancer will be able to get some drugs shown to help prevent the disease without a co-pay, the Obama administration said Thursday.

The panelists discuss clinicians and their perspectives on financial constraints in treatment of NSCLC.

Dr Peskin begins by stating, costs are exceedingly consequential. Cancer care and treatment is occupying, and with demographics being what they are, increasingly larger relative total cost of care across the US, including various national organizations.

Dr Peskin discusses programs such as Choosing Wisely and how providers must be mindful of high value, cost-conscious, cost-aware care.

A look back at some of the InFocus blog highlights of 2013.

Panelists discuss screening recommendations and guidelines, including considerations for screening those patients with a smoking history.

The panelists weigh in on the appropriate standards for treating patients with NSCLC.

Dr Langer suggests that historically, there's been a monolithic approach to treating NSCLC.

Moderator Michael Chernew, MD, introduces panelists as they discuss the treatment overview of non-small cell lung cancer (NSCLC).

The coming year will be one for those who have beaten cancer to develop survivorship plans, with the Commission on Cancer to require planning by treatment centers starting in 2015.

The final panel of the conference analyzes the role of the industry in healthcare, including panelists' observations on topics such as innovation. Mr Gamble, for instance, offers his insights as to how groups like the Community Oncology Alliance are working with the industry to drive the message about the quality and the value component throughout all the stakeholders. Dr Fox provides perspective on how payers can offer valuable partnerships throughout the industry, including those with pharmaceutical companies.

Dr Cliff Goodman leads a discussion featuring panelists including The American Journal of Managed Care's co-editor-in-chief, Dr Michael Chernew. Topics of the discussion include the impact of value-based pricing in the market, and how different pricing models such as bundled payments or accountable care organizations impact risk factors.

According to Dr Ramsey, both the Health Economics Outcomes Research (HEOR) model and the pharmaceuticals pricing model in the United States are broken. He says: Unless we, as a community, figure out a way to use health economics in our decision making, we are not going to stop this train of unsupportable price increases in pharma.

Mr Klein leads another discussion with Michael Kolodjiez, MD, Lee N. Newcomer, MD, MHA, John L. Fox, MD, MHA, and Jerry Conway. The panel responds to whether there are gaps in targeted gene analyses. They also discuss other issues including bioinformatics, and how payers, providers, and pharmacists might collaborate on improving care through genetic sequencing.

Jerry Conway provides a DNA-centric view of organizing treatment plans with respect to the use of some advances in genomic technology.

Dr Klein moderates this discussion, including co-editor in chief of The American Journal of Pharmacy Benefits Dr Jan Berger. The panel addresses a variety of topics as they relate to companion diagnostics in targeted treatments. Panelists respond to issues such as who should take responsibility in genetic counseling to ensure that patients have the best experience possible-whether it be in person or telephonic. Other topics covered in this discussion include appropriate consumerism in this space, the employer's role in genetic counseling, and how medical professionals are being trained or educated about these processes.

Karen uses this session to analyze payer perspectives in genetic counseling. She describes the process involved with genetic counseling and the role of the counselor. She notes that the path to becoming a genetic counselor can often be more rigorous than in other specialties. Ms Lewis also discusses the surge of interest that genetic counseling has seen in recent years.

Bruce Feinberg, DO, vice president and chief medical officer of Cardinal Health Specialty Solutions, Clinical Pathways, begins this next segment from a different perspective.

Dr Klein begins the panel discussion by asking participants to name one of their biggest challenges. Dr Newcomer responds that time and the fact that there are not enough PhDs are challenging. Ms Torda suggests that standardized data and data collection remains difficult. Dr Scanlon says it's the nimbleness of structuring data.

Dr Newcomer says that he welcomes the transition of oncology from being evaluated in process measures to outcome measures. He says that while quality measures can be quick and messy, these results are used for the purpose of finding gaps and seeing if those gaps can be improved.

Implications of Healthcare Reform: 'No' Will Be Heard is led by Cliff Goodman, PhD, in a panel discussion featuring A. Mark Fendrick, MD, co-editor in chief of The American Journal of Managed Care, John L. Fox, MD, MHA, and Ira M. Klein, MD, MBA, FACP. The panelists determine what it means when a patient says no.

Ethan Basch, MD, a self-described triple-threat, discusses incorporating patient-centered outcomes into clinical trials. He begins his presentation by describing a colleague's published research article, Pazopanib versus Sunitinib in Metastatic Renal-Cell Carcinoma. The study found that not only did Pazopanib cost an estimated $5800 and Sunitinib $7800, but Pazopanib was superior to Sunitiniib in 11 out of 14 quality-of-life indicators.

Dr Peter Bach says professionals are looking at opportunities for new payment models and care redesign, but there are also threats that might surface. Each type of insurance payment model has different levels of risk factors. New payment models, such as the UHC pathways program and CMMI demo, have limited risk.

The value of genetic testing in breast cancer is subject to debate, but it also holds promise. One recent clinical trial simulated by a group of researchers, for instance, found that the 7 single-nucleotide polymorphisms (7SNP) genetic test for breast cancer was cost-effective when used for MRI screenings in patients at intermediate risk of developing the disease over their lifetime.

All the economic studies of genomic tests for breast cancer rely on modeling rather than randomized controlled trials or other direct trial data.