How Can We Identify the Value of Personalized Medicine in Cancer?

At Cancerscape, the Association of Community Cancer Center’s 42nd annual meeting on policy, value, and quality, ongoing in Washington, DC, Kavita Patel, MD, MS, senior fellow at the Brookings Institution, spoke about the clinical imperatives of personalized medicine, with considerations for curbing healthcare costs and simultaneously demonstrating value to all stakeholders.

Can Value and Personalized Medicine in Cancer Care Co-Exist? Was the question Patel posed. “I always thought as a clinician, my entire life was dealing with personalized medicine. So what has changed?”

Patel said that oncologists and physicians overall have to start thinking about where they will you position themselves in the new value-based payment models and value-based care? “Where can you insert value-based practices in your clinic?” she asked.

Drawing a simile with Tesla, a luxury offering that promised reducing the carbon footprint, Patel said that Tesla received tremendous subsidies from the federal government because of the value-proposition they presented for their expensive vehicle. “We need to come up with our own models and metrics, rather than have the government tell us what to do with respect to value,” Patel told the audience.

She said that as we are trying to prepare our patients for the onslaught of costs coming from the therapies that are being developed, “we need alignment between what we are telling the various stakeholders, including physicians, payers, and patients.”

A few of the strategies that Patel proposed included:

• Targeting mechanisms that lead to cancer progression to improve outcomes
• These mechanisms are individual or personalized
• The goal should be to identify the mechanism of progression so we can specifically target it.

“Precision medicine boils down to taking each patient, identifying the best clinical evidence, identifying the molecular mechanisms, and then selecting the best algorithm that considers the longevity of treatment and screening and follow-up,” Patel added.

The best solution, in her opinion, to improve outcomes with targeted therapies is to test the algorithm used rather than the drug being used in the treatment.

How is value being defined today? Patel emphasized the utter lack of clarity around “value”. Value, she said, has been a fad that has now become a reality, but the definition seems far removed from reality. “You cannot be held responsible for measures that do not make sense for the population you take care of!” Patel remarked.

“Patients trust us, we are their point person, and we are accountable for their health, not the hospital. This needs to be considered in these value-based models,” Patel said.