Table 2 I-O specific elements to enhance traditional value calculations
From: The promise of Immuno-oncology: implications for defining the value of cancer treatment
Costs (numerator considerations) | Net Prices vs. List Prices | Wholesale acquisition costs may significantly overestimate the true cost of a drug. We recommend accounting for discounts and rebates where appropriate to reflect the true price paid for the new therapy. |
Consider alternate stakeholder perspectives | More research emphasis on a societal perspective – While many payers require a focus on the health sector specific costs, to fully understand the costs and benefits of a drug to society taking a societal perspective (accounting for caregiver costs, productivity gains/losses, etc.) in costeffectiveness analysis is warranted. | |
Effects (denominator considerations) | QALY | Many economic models are sensitive to the variations of the utility value used for each health state. We recommend engaging current or former patients as advisors to validate the assumptions made with the base case QALY inputs as well as the sensitivity analysis. |
Life Years | Conduct the same analysis with no QALY adjustment so that absolute mortality reductions can be easily reported for the decision-maker. | |
Patient Specific | Identify other potential outcomes as denominators by engaging current and former patients. Addressing the outcomes that “matter” to patients can help decision-makers compare drugs within the same disease state for the specific population that it is impacting. Consider stratifying analyses based on risk tolerance of patient subpopulations. | |
Other factors (beyond the incremental cost effectiveness ratio) | Value of Hope | The ISPOR Special Task Force identifies this as an area needing more research to quantify, but it is conceptually intuitive and very relevant to IO. A cancer patient facing a terminal diagnosis may be willing to risk taking a more novel therapy if his or her chances include the possibility of durable response and even functional cure. |
Real Option Value | For a cancer patient, any innovation that can extend life (even at the same or worse quality of life) may give a patient a chance to live long enough for a new treatment to develop, possibly even a cure. | |
Scientific Spillovers | New mechanisms of action may or may not benefit current patients, but we often fail to consider the steps in the path to future discovery. Without learning from the research in the 1950s, would we be here today with ~ 26 IO regimens benefitting thousands of patients? |