How much longer do I have to live? How much am I willing to pay for treatment? What side effects am I willing to bear?
These aren’t easy questions. So health care providers and insurance companies are trying to help doctors guide their patients through the process with tools that aid in selecting the best treatment regimens.
In June, the American Society of Clinical Oncology released a framework it hopes physicians eventually will use to compare new cancer therapies with established treatments — the clinical benefits, side effects, and costs.
Last year, Anthem produced a program designed to determine the best treatment options for some cancer patients and provide incentives for physicians to prescribe those treatments.
Such efforts face a common limitation: They do not adequately reflect the complex range of issues that inform patient treatment decisions. For example, some incorporate only drug prices into their cost models — one issue of concern to patients, but not the only one.
Developing precision treatments can be expensive, and the resulting prices for these specialty products can be high. Because novel therapies are often introduced to patients with advanced diseases, they may demonstrate only a modest benefit.
In the latest issue of JAMA Oncology, for example, researchers attempted to determine an appropriate price for an experimental lung cancer drug that extends life, according to clinical trial data, by between six weeks and two months, on average, for some stage-IV lung cancer patients. They calculated a low value for the treatment.
If patients’ decisions about novel treatments are determined by rigid calculations of narrowly defined costs versus benefits, they’ll shy away from these treatments — or insurance companies may restrict or deny access to them.
My organization, the Patient Advocate Foundation, provides case management support to tens of thousands of patients each year suffering from financial hardships. Last year, the primary medical debt issues for our patients were transportation expenses, followed by co-pays for hospital and doctor visits.
To make an informed decision about a treatment’s value, patients need to know much more about their likely out-of-pocket costs, beyond just the relevant medications.
People consider a wide variety of factors when buying a new car or refrigerator. Surely, applicable lessons exist for health care, especially with consumers shouldering an increasing share of their costs.
Frameworks can be designed to enable physicians to help their patients navigate health care decisions. But the frameworks also are likely to be used to determine what the patient can receive and what will be covered by insurance.
To avoid inappropriate rationing of care or limiting of choice that may be contrary to a patient’s best care, these tools should address myriad risks, costs, and benefits that reflect the complexity of treatment choices.
Patients and their providers don’t benefit from rigid formulas based on limited variables; they need sophisticated models that allow patients to determine what is important and then compare treatments.
In a consumer-based medical system, this approach will ensure that treatment decisions are based on the needs of the individual patient.