Episode 10 - Measuring Economic Burden or Value Against Clinical Outcomes

While discussing the factors that managed care professionals review when assessing a pharmaceutical product’s cost versus its overall benefit, the panelists explain that the process is often challenging.

Oncologists and other health care providers, along with the FDA, must assess several factors, most importantly a drug’s risk-benefit ratio, before deciding how to approve it. And in the United States, there is no current threshold for what constitutes a reasonable price on drug therapy or helps determine what necessary approaches can help pay for expensive therapy, clarifies Michael Kolodziej, MD.

Because the money that is being spent to help pay for expensive therapy comes through insurance agencies, from taxpayers’ dollars, reminds Dr Kolodziej, the decision about how to pay for expensive treatments such as immunotherapy should be a societal decision.

The panelists agree that as our country shifts toward a value-based insurance design, the consumer will have to become more active in the economic decision-making process.

Daniel J. George, MD, explains that the decision-making process will rely heavily on providers, as they will need to supply the information important to patients so that they can make valued decisions.