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Assessing and Improving Value in Cancer Care: Workshop Summary
tive is usual care with a known mortality risk. Some view cost concerns as unimportant, or even inappropriate and offensive, when considering treatments that might improve survival. In addition, the health care delivery system’s incentives favor treatment over many other important steps, such as providing patients further information, comfort measures, or end-of-life planning, and these may take second place to costly interventions.
The task set out for this workshop by the planning committee is to address issues related to value in cancer care by identifying agreement in our understanding of value and providing policy tools that can lead to improvements in the value of cancer services provided to patients, said Dr. Ramsey. It is important to discuss terminology used to describe value and the metrics used to measure it, since discussion becomes difficult without a mutual understanding of what is meant by the term value. There is no one description of value that everyone agrees on, which is why it is important to understand what constitutes value from the perspectives of many stakeholders—patients, clinicians, payors, industry, and others. We hope that a greater understanding of value from various perspectives will help us jointly weigh the costs of treatments with their risks and benefits.
Many descriptions of value have been proposed previously and may be useful for understanding value in cancer care. Definitions of value in the Merriam-Webster dictionary (Value, 2009) focus largely on a return for a cost in terms of goods or services. They often focus on money, worth, and numerical quantity. This parallels themes at issue for value in oncology— relative worth, fair return, costs, and measures of quality.
Health systems in countries worldwide have described value so that stakeholders in these countries have a common framework for discussion. The European Observatory on Health Systems and Policies (Sorenson et al., 2008) describes value as follows: “Value includes patient preferences, quality, equity, efficiency, and product acceptability among a wide range of stakeholders.” Interestingly, cost is not explicitly mentioned here. The United Kingdom’s National Institute for Health and Clinical Excellence (NICE) states, “The value of a treatment is based on scientific value judgments, including clinical evaluation and an economic evaluation, and social value judgments, including considerations of efficiency and effectiveness” (Rawlins, 2004). Notice that it focuses on scientific and clinical judgments, and that economics, social judgments, efficiency, and effectiveness are also included. In the United States, Pharmaceutical Research and Manufacturers of America (PhRMA) states that “The value of new and better medicine stems not only from the improved treatment of disease but also from a