On the value of innovative cancer treatments

Today’s post is by Andrew Oxtoby, Vice President, International Oncology Business Unit, Eli Lilly & Company 

Policymakers are searching for solutions to address the burden of cancer: they redesign cancer care systems and reallocate healthcare budgets based on what they believe can deliver the greatest value. However, vastly different perspectives of what constitutes “value” in cancer care represent a barrier to achieving the best possible outcomes for patients. There is therefore a need to try to bridge these different views between cancer care stakeholders and policymakers in Europe.

This was the main conclusion of a discussion I participated in last weekend, during the European Cancer Congress. I was sitting in the panel of a policy debate entitled ‘Navigating perspectives on value of oncology innovation’, alongside colleagues from political, patient advocacy, payer, medical and academic backgrounds. I found that Member of the European Parliament Mr Van Nistelrooij summarised a policymaker’s dilemma rather clearly. When policymakers choose how to prioritise resources for cancer interventions, they need to know what is most valuable. But there are many challenging questions: valuable to whom? according to which criteria? what does this mean for the long-term?

Value has been a buzz-word for years now, yet no generally accepted definition exists when it comes to the value that innovative oncology treatments bring. At Lilly, we believe that we’ve come a long way in the fight against cancer: since 1975, the chances that a cancer patient will live 5 years or longer from diagnosis have increased by 41% across cancers.[1] In certain instances, cancer has become a chronic, treatable and survivable disease. And 83% of these survival gains are attributable to new cancer treatments – including medicines.[2] So yes, I do believe that innovative cancer medicines bring value for both patients and healthcare systems alike.

But I also believe that the way we look at value today is not fit-for-purpose. Most authorities assessing the value of innovative cancer treatments (HTA authorities) look at a medicine’s clinical benefits for the individual patient at a single moment in time and in isolation from the care system it is used in. They do not necessarily take into account the positive impact the medicine can have in reducing the use of other, more costly interventions, such as hospitalisations, or enabling people to return to a normal, productive life, or even the benefit for the society in the longer term. This approach risks focusing more on containing budgets, rather than improving outcomes.

When it comes to assessing the value of innovative cancer medicines, we need more flexible, outcomes-focused approaches that take into account the medicine’s value for the patient, the wider healthcare system and the society. We need an approach that ties rewards to specific results achieved, rather than today’s link to the amount of treatments sold. We believe that access to the best medicines is critical for patients. Striking the right balance between healthcare budgets sustainability and encouraging future innovation should be one of the highest priorities of all stakeholders in the cancer community, physicians, industry, payers, patient advocates and policymakers alike.

[2] E Sun et al, Determinants of Recent Gains in cancer survival, Journal of clinical oncology, May 2008, Suppl, Abstract 6616