How to create value with constrained budgets in oncological care? A narrative review

ABSTRACT

Introduction

As a result of an increasing focus on patient-centered care within oncology and more pressure on the sustainability of health-care systems, the discussion on what exactly constitutes value re-appears. Policymakers seek to improve patient values; however, funding all values is not sustainable.

Areas covered

We collect available evidence from scientific literature and reflect on the concept of value, the possible incorporation of a wide spectrum of values in reimbursement decisions, and alternative strategies to increase value in oncological care.

Expert opinion

We state that value holds many different aspects. For reimbursement decisions, we argue that it is simply not feasible to incorporate all patient values because of the need for efficient resource allocation. We argue that we should shift the value debate from the individual perspective of patients to creating value for the cancer population at large. The different strategies we address are as follows: (1) shared decision-making; (2) biomarkers and molecular diagnostics; (3) appropriate evaluation, payment and use of drugs; (4) supportive care; (5) cancer prevention and screening; (6) monitoring late effect; (7) concentration of care and oncological networking; and (8) management of comorbidities. Important preconditions to support these strategies are strategic planning, consistent cancer policies and data availability.

KEYWORDS:

• Healthcare costs
• oncology
• policy
• reimbursement
• value

Article highlights

• Clinical values are not the only ones that matter in the oncological field. A wide range of values exist.

• The concept of value in reimbursement decisions is getting more narrow as more expensive drugs are entering the market. In this narrow concept, there is limited room to incorporate all individual patient values.

• The value debate should shift from incorporating ‘all’ possible individual patient values in reimbursement decisions to creating more value for the entire oncological population as a whole.

• Many different strategies can increase value for the entire oncological population. These include shared decision-making, molecular diagnostics, appropriate use of cancer drugs, supportive care, prevention and screening, monitoring late effect, concentration of care and oncological networking, and management of comorbidities.

• Precondition for implementation of different strategies includes strategic planning, consistent cancer policies, and the facilitation of data availability.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.