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Of Value: A Discussion of Cost, Communication, and Evidence to Improve Cancer Care

University of California, San Francisco, School of Medicine, San Francisco, California, USA

Key Words. Value • Cost • Incentives • Evidence

Correspondence: Adam Schickedanz, B.A., 384 28th Street, San Francisco, California, 94131, USA. Telephone: 314-303-3309; e-mail: Adam.Schickedanz{at}ucsf.edu

Received July 16, 2009; accepted for publication September 15, 2009.

Disclosures: Adam Schickedanz: None.

The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias. No financial relationships relevant to the content of this article have been disclosed by the author or independent peer reviewers.

The U.S. spends far more per person than any other country in the world in treating cancer, without demonstrably superior results. Though the pursuit and pace of innovation in oncology are perhaps unmatched and promise great benefit for cancer patients, this explosion of innovation has been accompanied by dramatic increases in cost, often without significant increases in patient survival. These trends have led to a growing interest in addressing value—understood as treatment benefits or quality weighed against economic cost—in cancer care. In February 2009, the Institute of Medicine convened a group of experts with diverse perspectives, including those of clinical oncology, patient advocacy, the insurance industry, pharmaceutical manufacturing, health economics, and bioethics, to identify challenges to value in cancer care, suggest potential solutions, and discuss what value entails in oncology. This article presents many of the ideas that emerged from this symposium, including ways to correct misaligned economic incentives, improve clinical communication, and generate evidence to promote value in cancer care.

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