Table 1 Assessment of conventional value metrics in evaluating I-O therapies
From: The promise of Immuno-oncology: implications for defining the value of cancer treatment
Conventional value metric (examples) | Why insufficent For I-O | Areas where new I-O value measures are needed (beyond QALY) |
|---|---|---|
Clinical Efficacy Assessment OS, PFS, ORR | I-O therapies offer potential for durable response and due to delayed kinetics may not demonstrate early ORR or improvements in PFS | Milestone Survival; Treatment Free Survival |
Safety Assessment | Late-stage cancer patients may be more willing to accept high risk of toxicity for possible benefit (durable response); long-term impact of adverse events not fully known | More nuanced evaluation of patient preferences based on their risk tolerance and profile; longer follow up studies post treatment |
Patient Reported Outcome | Current measures fall short in measuring the value to patients of Treatment-free Survival; (extended time off treatment) | Treatment Free Survival impact on patient’s QoL; Hope for durable response |
Economic Measures, e.g. Cost of ongoing treatment; Cost of treatment for side effects; cost of lost productivity | Typically focuses on patient-related expenses or drug cost during active treatment | Return to productivity; Economic benefit of Treatment-Free Survival, including reduced expenditures on ongoing treatment, scans and other follow up; Amortize costs over the longer horizon of benefit in a “cure-rate” model; consider other stakeholder fiscal impact |