Cost, Coverage, and Comparative Effectiveness Research: The Critical Issues for Oncology

Pearson, Steven D.

doi:10.1200/jco.2012.42.6601

Cited by 22 publications

(13 citation statements)

References 26 publications

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“…CER has the opportunity to bring the data and discussion to a level of clarity and transparency for more rational and balanced choices in both regulatory and reimbursement decisions by providing a formal process for evaluating the totality of evidence on the effectiveness, safety, and value of available interventions. Hopefully, this will lead to greater reliance on scientific evidence in clinical practice and health care policy and coverage [54]. We should examine comparable national health care coverage systems in other developed countries and learn from both their successes and their failures in an effort to develop a high-quality and yet affordable and sustainable health care system that provides reasonable and compassionate coverage for all of our citizens.…”

Section: Social and Political Challengesmentioning

confidence: 99%

Comparative Effectiveness Research in Oncology

Lyman

2013

The Oncologist

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Although randomized controlled trials represent the gold standard for comparative effective research (CER), a number of additional methods are available when randomized controlled trials are lacking or inconclusive because of the limitations of such trials. In addition to more relevant, efficient, and generalizable trials, there is a need for additional approaches utilizing rigorous methodology while fully recognizing their inherent limitations. CER is an important construct for defining and summarizing evidence on effectiveness and safety and comparing the value of competing strategies so that patients, providers, and policymakers can be offered appropriate recommendations for optimal patient care. Nevertheless, methodological as well as political and social challenges for CER remain. CER requires constant and sophisticated methodological oversight of study design and analysis similar to that required for randomized trials to reduce the potential for bias. At the same time, if appropriately conducted, CER offers an opportunity to identify the most effective and safe approach to patient care. Despite rising and unsustainable increases in health care costs, an even greater challenge to the implementation of CER arises from the social and political environment questioning the very motives and goals of CER. Oncologists and oncology professional societies are uniquely positioned to provide informed clinical and methodological expertise to steer the appropriate application of CER toward critical discussions related to health care costs, cost-effectiveness, and the comparative value of the available options for appropriate care of patients with cancer. The Oncologist 2013;18:752-759 Implications for Practice: Escalating health care costs, largely driven by expensive new technologies and therapies, have prompted calls for more rigorous assessment of the effectiveness, safety, and overall value. At the same time, the time and resources required for large randomized controlled trials, as well as their recognized limitations, necessitate consideration of other forms of comparative effectiveness research for evaluating meaningful clinical outcomes. Through the results derived from selective and appropriate use of a range of comparative effectiveness methodological tools, clinicians, patients, payers, and policy makers can make more rationale choices in selecting the most appropriate, efficient, and cost-effective cancer care. At the same time, practicing oncologists and other stakeholders must be aware of the challenges presented by such research approaches as well as the considerable progress that has been made in addressing these limitations in order to appropriately weigh the totality evidence on critical health care issues in every day oncology practice. INTRODUCTIONComparative effectiveness research (CER) attempts to compare the benefits and harms of alternative strategies for diagnosing, treating, or preventing disease in patients. Driven primarily by new therapies and technologies, health care expenditures c...

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Section: Social and Political Challengesmentioning

confidence: 99%

Comparative Effectiveness Research in Oncology

Lyman

2013

The Oncologist

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“…Costs should be considered through an explicit, rigorous process as part of guidance development, focusing not only on short-term costs but on longerterm cost-effectiveness, because some interventions that are more costly in the short term can provide substantial longer-term patient and health system benefits. 35,36 One article published more than a decade ago found a slightly lower percentage (31%) of all clinical guidelines citing at least 1 economic analysis, but the authors did not attempt to determine whether cost considerations were used to justify specific recommendations. 37 All 17 physician societies in our study indicating that they considered costs in developing guidance documents made at least 1 recommendation during the past 5 years in which cost was part of the justification; overall, more than onethird of their clinical guidance documents contained at least 1 specific recommendation with a basis in cost considerations.…”

Section: Aao-hnsmentioning

confidence: 99%

“…Although this kind of value judgment is controversial, we recommend that physician societies explicitly pursue this approach and consider in their guidance the relative cost-effectiveness of beneficial medical interventions because the judgment of physician societies is preferable to that of individual physicians "rationing at the bedside." 36,40,41 In the near future, more clinical care will be delivered by physician-led organizations, such as accountable care organizations that bear responsibility for health care costs as well as clinical outcomes. It thus seems timely for all physician specialty societies to consider costs when developing clinical guidance to help set standards for appropriate care.…”

Section: Aao-hnsmentioning

confidence: 99%

Cost Consideration in the Clinical Guidance Documents of Physician Specialty Societies in the United States

Schwartz¹,

Pearson²

2013

JAMA Intern Med

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“…clinical decisions. 37 The use of evidence to improve health care quality while lowering costs will continue to guide clinical practice, 21 and it will be critical for neurosurgeons to maintain a strong understanding of health economics, decision analytics, and the methodology of cost-effectiveness research in order to remain at the forefront of health leadership and innovation.…”

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confidence: 99%

Markov modeling for the neurosurgeon: a review of the literature and an introduction to cost-effectiveness research

Wali¹,

Brandel²,

Santiago-Dieppa³

et al. 2018

Neurosurgical Focus

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OBJECTIVEMarkov modeling is a clinical research technique that allows competing medical strategies to be mathematically assessed in order to identify the optimal allocation of health care resources. The authors present a review of the recently published neurosurgical literature that employs Markov modeling and provide a conceptual framework with which to evaluate, critique, and apply the findings generated from health economics research.METHODSThe PubMed online database was searched to identify neurosurgical literature published from January 2010 to December 2017 that had utilized Markov modeling for neurosurgical cost-effectiveness studies. Included articles were then assessed with regard to year of publication, subspecialty of neurosurgery, decision analytical techniques utilized, and source information for model inputs.RESULTSA total of 55 articles utilizing Markov models were identified across a broad range of neurosurgical subspecialties. Sixty-five percent of the papers were published within the past 3 years alone. The majority of models derived health transition probabilities, health utilities, and cost information from previously published studies or publicly available information. Only 62% of the studies incorporated indirect costs. Ninety-three percent of the studies performed a 1-way or 2-way sensitivity analysis, and 67% performed a probabilistic sensitivity analysis. A review of the conceptual framework of Markov modeling and an explanation of the different terminology and methodology are provided.CONCLUSIONSAs neurosurgeons continue to innovate and identify novel treatment strategies for patients, Markov modeling will allow for better characterization of the impact of these interventions on a patient and societal level. The aim of this work is to equip the neurosurgical readership with the tools to better understand, critique, and apply findings produced from cost-effectiveness research.

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Cost, Coverage, and Comparative Effectiveness Research: The Critical Issues for Oncology

Cited by 22 publications

References 26 publications

Comparative Effectiveness Research in Oncology

Comparative Effectiveness Research in Oncology

Cost Consideration in the Clinical Guidance Documents of Physician Specialty Societies in the United States

Markov modeling for the neurosurgeon: a review of the literature and an introduction to cost-effectiveness research

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