!6" #$%&'()*+,#$%&'()*+,-./012./012
3CSP!HOR456
789:;<=%>?@ABC?@DEFE
2012/07/07GHIJKLM7MNOPQRS TUVWXY!2N :;<=%>?@ABC?@DEFE

Z[\]^_F`:;<=%ab]cQRd=e-fghi
jklmno pqrs«¬­Z[\yt@uvw:;<=%xyz{|`@}]c~9-$ • L-$!GKOL>IL
$!G>I• ASCO p
plenary"session"9ypresentationp• NEJM /"JCO?9• FDA"9
FDA 9
• NCCN"?9 GL"9• a9C• Drug LagG\C ¡¢£CM6¤9¥¦I• §¨©ª¤EBM,"medical"oncology,"íU79îÁuï• L³®GRCTI¯°´,"±µ²¶µ=·¸L ®GI¯° ± ²¹º|v»`EvidenceyC¼½¾¿ÀÁÂB`Ã• ÄÅ·yÆÇ9limitationGÈÉÊ9ËÌÍI]«|vÎÏCconclusionG¯ÐI9ÑCÒÓ98Ô>ÕÖ·×ØF`Ùy»Ã• ðE·CEñvòó]ôõÇCå{9ö{|÷æ·¼øÇ3ùúûGSBMI48yüýu÷Ã

• ÚÛ9 ¡98ÜÝ·yCÞß¾·y¡98ÜÝ·y Þß¾·y ¡9àáCâãC:;<=%Cäuvå{9æ>çè¾·Âéuv decision"making">Ó@Ã
dk >Ó@• Þêy»]CÞë>ìÇFÃ

• ,-M9íU\yC:;<=%·.{/|,-M9íU\y :;<=%·.{/| 01÷2BC ¡·:;<=%>34F`9yÇÇC:;<=%·;<· ¡>567634º8`$@·9÷Ã

EBM,"medical"oncology,"íU79îÁuï!2

êu»S6TU• :;<=%9»:;9 ¡·y8<=»Ã
ÃG>º¬1?=5cc,?gC>º¬@ABI, g• :;<=%C^9÷­·CDEF&>­÷
8ÜÝG ¡·Á9v9Þë98ÜÝI>ôõ·GHGGII<=»Òà]&`Ã• ¡!7JK9ÌLMN9OPCQR-*Ä5mGIa• þÿÁuvC !M¾·"#º|÷L³®
·$Ï Z[¾·Ì%9&`8'(])
·$ÏCZ[¾·Ì%9&`8'(])#º|CEBM9ÂB]*+u÷Ã

• V ¡9WXk¡ WX• 78Y9WZÁ5[78• \>]^»Á»_»\`K9Ma• EBMªb·cdF`:;<=%9»ef(¿ÀC5gh
¿ÀC5ghmedia¿À¿À– ijkCWlm;en=Cop8ÔC+=qr8ÔCstC
uv8ÔCCCCCGw·xy·9÷Îz{·yËÌI
– |'%9V]jB÷C}=¾·~¾V8·]`C78Ya 78Y9àÄ215m9a 78Yy3667C
Û5m
Û5m9348084·³³11983C3.49úÁ
9v»`Ã
÷Ï9a 78Yy282400C
Û5m9272600·³
3.6úuv»`Ãa 78Y9amç(GDP)·F`³y7.60
GÛ5m7.07ICa I(NI)·F`³y10 61GÛ5·F`³y10.61GÛ5m9.89IÁ9v»`Ã

Z[\]ÂéF_ÍZ[\]Âé
Z[\]ÂéF
FF_Í_Í
_ÍValueGG ¡·Á9v9IValue“Clinically relevant” decision making!"#$%&'()*+,%-./01234

!"#$%&PFS/OS!"#$%&PFS/OS'()"#%&*+,-./012-34567'89:;'()"#%&*+,-./012-34567'89:;

PFS<=>?@ABCD

OS<E@ABCD!FGHValue!FGH!FG
ValueIJKL9M
Value
IJKL9M
JKL9M

Clinical!
Benefit

ContExp

HRPCont

ExpHRP

Clinical!
BenefitB
fit

New!Drugg Cost/Year!of!New!Drug/g

Pancreatic,
Gem± Erlotinib

3.6

3.8

0.77

0.004

5.9

6.2

0.82

0.038

Very!Low

Pancreatic,
Gem± Erlotinib

Very!LowErlotinib$53,954

Very!Low

Hepatoma,!
BSC± Sorafenib

2.8

5.5

0.58

<0.001

7.9

10.7

0.69

<0.001

ModestHepatom,a,!
BSC± Sorafenib

ModestSorafenib$115,866

Low

Gastric,!
Gti
FP/CP± Trastuzumab

5.5

6.7

0.71

0.0002

11.1

13.8

0.74

0.0046

ModestGastric,!
FP/CP± Trastuzumab

ModestTrastuzumab

Biliary,
Gem± Cisplatin

ModestCisplatin$364

HigherNET,!
BSC± Sunitinib

HigherSunitinib$108,569

Higher

NET,!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
BSC± Everolimus

HigherEverolimus$201,516

BiliaryBiliary,
Gem± Cisplatin

5.0!

8.0!

0.63

<0.001

8.1

11.7

0.64

<0.001

Modest.
NET,!,
BSC± Sunitinib

55
5.5

11 4
11.4

0 42
0.42

<0.001
0 001

early
l

0 41
0.41

0 02
0.02

Hi hHigher

NET,!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
4 6 11.0!
4.6
11 0 0.35
0 35<0 001<0.001
early
1 05
1.05
0 59
0.59
Higher
BSC± Everolimus
Moore,!JCO!2007;!Llovet,!NEJM!2008;!Bang,!Lancet!2010;!Valle!NEJM!2010;!Raymond,!NEJM!2011;
Yao,!NEJM!2011
Meropol,!ASCO!2011$51,225!!!!!!!!!!!!!
(Exclude!Loading!dose)

Value?

ModestModestMeropol,!ASCO!2011

The!Rising!Cost!of!Cancer!Care:!
ASCO!daily!news!2012
Physicians Take!Charge
Advancing Medical Professionalism to Improve Health Care

1.!Brody!H.!Medicine’s!ethical!responsibility!for!health!care!reform:!The!top!five!list.!
N!Engl J!Med.!2010;362:283" 285.
2.!Schnipper LE,!Smith!TJ,!Raghavan D,!et!al.!American!Society!of!Clinical!Oncology!
identifies!five!key!opportunities!to!improve!care!and!reduce!costs:!The!top!five!list!
for!oncology.!J!Clin Oncol.!2012;30:!1715"1724.

1 PS!3,4[NOPQRSTUGP.[34VW$XYZGP.[
1.
PS 3 4 NOPQRSTUGP. 34VW$XYZGP.
"#\]$NOP^_GP.[`abcd$ef'gh"#JijP ;"#JijP.;
2. klGmUnGo.pBqrsbcd$PET,!CT,!tuTv
JijP.;
3. klGmUnGo.pBwbcd$PET,!CT,!tuTvJikln o pBwbcd
tuJijP.;
4 "xyz{G=|}wbG~$4.
"xyz{G=|}wbG~$JijP.;
5. ZGmUn'20GcdG5Z mdGCSFeijP.;