Gaining Control of Combination Cancer Treatment Risk by Incorporating Cost and Value Data into the Drug Selection Process at the Point–of–Care
Authors: Nicholas Richard L. 
Published: February 2022

AbstractThe use of combination therapies*, as well as FDA-approved drugs for off-label indications, to treat advanced cancer, is widespread. While much is known about their clinical effectiveness, there exists no examination of the relative cost of novel multidrug combinations vs. traditional available therapy options, or study as to how knowledge about comparative therapy costs at the point-of-care can be leveraged by doctors, health systems, and payers. We found that:combination multidrug cancer regimens may be less costly than monotherapies or other standard options;novel, multidrug combinations are often better financial values than monotherapies or other standard options;having treatment cost and value data, at the point of care, enables the prompt selection of more cost-effective medications and the avoidance of expensive low-value therapies that are financially wasteful.We conclude that the effectiveness of value-based purchasing initiatives may be amplified if physicians and payers use comparative treatment cost/value data to enhance their cancer drug-selection decision making.* Including combinations of immunotherapies, chemotherapies, targeted drugs with distinct mechanisms of action, etc.Study HighlightsWhat Is The Current Knowledge On The Topic?☑The effectiveness of molecularly targeted multidrug therapies used to treat advanced cancer is well established;1-4that few clinicians are aware of the cost of the medications they prescribe, or which are more cost-effective, deliver a better return-on-investment or represent a financial value;8and, that it is intuitive to believe that a combination of multiple high-cost medications is more expensive than a single-drug or other standard therapy options.What Question Did This Study Address?☑Although studies on the clinical impact of multidrug cancer treatments abound, 1-4there are no examinations of the relative cost or value of combination therapies vs. that of traditional monotherapies, or how knowledge of how this data can be used in practice. A systematic method to calculate, evaluate and compare the relative cost of mono-therapies, 2- and 3-drug combination cancer therapy options is presented for use by physicians, health systems and payers to better manage their oncology specialty pharmacy spend and drive better medical outcomes. 3What Does This Study Add To Our Knowledge?☑We show that multidrug cancer therapies are not necessarily more costly than single-drug or other standard therapy options; and that furnishing physicians and payers with comparative treatment cost and value data to augment their complex medication selection decision making enables them to identify drugs that are a value, avoid those that are wasteful, and create better targeted novel combination cancer therapies that represent a value, which incorporates both clinical and financial aspects.How Might This Change Combination Therapy Drug Selection Or Value-Based Oncology Management?☑Clinicians have the tools, information, and data with which to confidently prescribe novel drug combinations that customize molecular targeting, and lower treatment costs. Payers now have a framework within which to drive value-based purchasing to gain control of their oncology specialty drug risk. Patients will benefit from more personalized, efficient and effective therapies and less financial toxicity (i.e., distress).