Dr Jennifer Vaughn: Value-Based Care Concerns Cost and Patient Experience

Oral chemotherapy agents offer patients a reprieve from fees and facility costs, but they also put the cost of vital medications on the patient, highlighting an area of need, discusses Jennifer Vaughn, MD, assistant professor in the division of hematology at The Ohio State University Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute.

Transcript

What strides are being made to improve and expand access to value-based care in hematology, and what more needs to be done?

Hematology, in itself, is a unique space in that we've had a lot of very rapid development and very effective, but also very expensive therapies, over the last couple of decades. I think some particular spaces that we really need to think about how we're going to create a value-based care experience for our patients are in the aggressive treatments of hematologic malignancies, with modalities such as stem cell transplant, CAR T therapies, gene therapy.

I sit in our classical hematology section within our division and work closely with hemophilia and sickle cell disease physicians, who very soon will have access to these types of therapies for their patients. And obviously they carry with them a lot of cost, so as we're planning how we're going to provide these treatments, thinking about other ways we can streamline those processes and provide the supportive care that the patients are going to need in order to truly make the experience a valuable one, both from the financial standpoint but also from the viewpoint of the patient.

The other interesting component of hematology and value-based care that I feel very passionate about, and have done a little research in, is the concept of financial toxicity that patients experience when we are administering oral chemotherapy agents. In hematology, our use of oral agents for treatment of malignant diseases is increasing very rapidly, and it's really shifted the responsibility of administering drugs from the clinic and the infusion center to the patient and the caregiver.

It does save costs in that it avoids all of those fees from the facility, the infusion center fees, but what it does then is it places the cost in the hands of the patient as well. I know many of my patients have been faced with fairly large copays to pay for drugs that they need for life-sustaining therapy, simply because their insurance coverage is done in a different way so that they have a lot of costs for orally administered drugs, where they might not have that cost for infusions.

[We’re] really looking into how patients are being affected by this and how we can help mitigate those costs. Obviously, lots of health care systems have systems in place that can support patients through getting grants and assistance from drug companies and things of that nature. I've talked to many patients who say even the process of going through those applications is extremely anxiety provoking and really does impact their quality of life.

From that standpoint, not only are they having to deal with this diagnosis that's overwhelming, but now they're dealing with paperwork and fear that they may lose resources of their own in order to pay for their treatment. I think that's a real area that we need to be thinking about as we create value-based care programs in hematology itself.