Comparing Treatments by Efficacy, Toxicity, and Cost

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Last year, five organizations introduced new methods to compare cancer treatments. For more on ASCO’s Value Framework, see page 120.

The NCCN Evidence Blocks™ use a simple graphic to show experts’ ratings of systemic therapies in five areas: efficacy, safety, quality and quantity of evidence, consistency of evidence, and cost. Cost is defined broadly to include drugs, supportive care, and hospital stays, among other factors.

ASCO’s Value Framework tool uses data from randomized clinical trials to calculate a numerical “net health benefit” for each regimen, based on survival and toxic effects. Cost, reflecting a patient’s estimated out-of-pocket cost for drugs, is presented separately.

The Institute for Clinical and Economic Review (ICER), has designed its Value Assessment Framework for use by both policymakers and clinicians. As the U.S. Food and Drug Administration approves new drugs, ICER will assign to each one a “care value” reflecting clinical benefit plus cost effectiveness, and a “health system value” showing how the drug affects the health system budget.

The Magnitude of Clinical Benefit Scale (MCBS) from the European Society for Medical Oncology rates drugs based on survival data, response rate, prognosis of the condition, quality-of-life data, and toxic effects, but not costs. The scale will be applied prospectively to new anticancer drugs approved by the European Medicines Agency. Those with the highest ratings will be noted in the society’s clinical practice guidelines.

Memorial Sloan Kettering Cancer Center’s DrugAbacus Tool compares the cost of more than 50 cancer drugs with what the prices would be if they were tied to factors such as toxic effects and survival. The DrugAbacus website ( calls it the “first draft of a tool that could be used to determine appropriate prices for cancer drugs based on what experts tend to list as possible components of a drug’s value.” ■

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