Dr Stephen Grubbs Discusses Creating ASCO's Value Framework

Many value assessment frameworks are still in their infancy and while the American Society of Clinical Oncology (ASCO)'s framework is still getting input and being adjusted, it has started an important conversation, Stephen Grubbs, MD, vice president for clinical affairs at ASCO, said at the Community Oncology Alliance's 2016 Community Oncology Conference.

Transcript (slightly modified)

What distinguishes the ASCO Value Framework from the National Comprehensive Cancer Network (NCCN)'s Evidence Blocks and the Institute for Clinical and Economic Review's Value Assessment Framework?

Right now, I think, we are all beginning to try to figure out what is the definition of value? And of course it depends on who is looking at it. The perspective I think we've had at ASCO, and really at NCCN, is looking at saying the value needs to be given to the patient for them to make a better-informed decision. So I think both of us have worked pretty much in similar ways, even though they're a little bit different, in trying to come up with some way of translating the benefits and risks of a treatment and it's cost to a patient at any point in time so they can begin to weigh out all of these factors in trying to make a better informed decision.

So I think NCCN and ASCO have a little different methodology to come up with, I think, a similar type of product to offer patients and their physicians to have that discussion. I can give the details of the ASCO program, and where we are with that is really the first attempt to try and define value for a patient to use. And it really needs to be adjusted and developed over time. So ASCO had a large commitee of our members, volunteers, and others put together a first shot at a value framework that was published last year in the Journal of Clinical Oncology.

Basically the framework works where one looks at the evidence of the benefit of the treatment—and the benefit will be defined as a high cure rate, a longer time in control of the disease, a longer survivorship—and along with that it measures against that the toxicity—and the toxicity meaning how the drug has negative effects on the patient. And what they've come up with is a numerical system to begin to develop a "net health benefit." The pluses are the benefits you get from treatment; the minuses the toxicities you pay. And once that net health benefit between 2 different treatments is calculated, then you begin to look at the cost differential between the 2 treatments.

This is really just started and it's not ready for primetime use and it has to have a lot of adjustments, it has to be developed even more, but it's started the conversation. There's input being put into it, and it's actually being adjusted as we speak and sometime this year it will be republished in a new form. But it's certainly on its way.