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VAL UE IN CANCE R CARE : F I NDI NG T HE PAT H T O - - PowerPoint PPT Presentation

Mar 02, 2024 687 likes •1.39k views

VAL UE IN CANCE R CARE : F I NDI NG T HE PAT H T O PROGRE SS Yousuf Zafar, MD, MHS, FASCO Associate Professor of Medicine, Public Policy, & Population Health Director of Healthcare Innoation Duke-Margolis Center for Health

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Yousuf Zafar, MD, MHS, FASCO Associate Professor of Medicine, Public Policy, & Population Health Director of Healthcare Innoation Duke-Margolis Center for Health Policy Duke Cancer Institute

VAL UE

IN CANCE R CARE :

F I NDI NG T HE PAT H T O PROGRE SS

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SLIDE 2

E mployme nt (spouse )

Sha ttuc k L a b s

Advisory Boa rd

AI M Spe c ia lty He a lth Vivo r, L L C Sa mF und

Boa rd of Dire c tors

F a mily Re a c h F

  • unda tio n

Re se a rc h funding

NI H Astra Ze ne c a

Boa rd Me mbe r

Co pe rnic us-WCG I RB

Consulting

RT I Mc K e sso n

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SLIDE 3
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SLIDE 4
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SLIDE 5
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SLIDE 6
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SLIDE 7
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SLIDE 8
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SLIDE 9
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SLIDE 10 Na ture , 2015

$13,000 a mo nth

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SLIDE 11

$289 $3232 $11,000

1980 2000 2016

P Ba c h. Me mo ria l Slo a n K e tte ring Drug Pric ing L a b
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SLIDE 12

Pric e of nivoluma b

$12,000 $12,200 $12,400 $12,600 $12,800 $13,000 $13,200

2016 2017 2018 2019

ASP Drug Pric e s, CMS.g o v
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SLIDE 13 Go rdo n e t a l, JCO 2017
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SLIDE 14

0% 50% 100% 150% 200% 250% 300% 1999 2002 2005 2008 2011 2014 2017

K a ise r E mplo ye r He a lth Be ne fits Surve y, 2017

E mploye r c ontribution to pre miums

270%

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SLIDE 15

$- $200 $400 $600 $800 $1,000 $1,200 $1,400 2006 2008 2010 2012 2014 2016

De duc tible s ha ve triple d

K a ise r E mplo ye r He a lth Be ne fits Surve y, 2017
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Ave ra g e c umula tive pa tie nt out- of- poc ke t c osts from time of dia g nosis

$- $2,000 $4,000 $6,000 $8,000 $10,000 $12,000

5 11 17 23 29 35 41 47

Millima n Re po rt, 2017

Mo nths fro m dia g no sis

L ung Colore c ta l Br e a st

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SLIDE 17

46% 46% 68%

F

  • re g o ne va c a tio ns

Cut g ro c e ry e xpe nse s

De ple te d sa ving s

n=254

Za fa r e t a l, Onc o lo g ist 2013
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SLIDE 18

Hig h fina nc ia l burde n:

Qua lity o f life a mo ng pa tie nts with a c tive c a nc e r a nd survivo rs

Za fa r e t a l, JOP 2014

n=1000 adjusted beta 0.06 EQ-5D unit per financial burden category; p<.001

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SLIDE 19

%

hig he r like liho o d

  • f no n-a dhe re nc e
Duse tzina e t a l, JCO 2013

Uppe r 75th pe rc e ntile >$53/ mo nth a RR, 1.70; 95% CI , 1.30 to 2.22

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SLIDE 20

Financial distress

Non-adherence

Missed appointments

Bankruptcy

Taking fewer medications Selling property

Spending savings

Delaying care

Declining tests

Buying less food

Buying less clothing

Using other people’s medications

Working longer hours

Cutting out vacations

Using credit

Borrowing from friends or family

Replaced prescriptions with

  • ver the counter medications

Spread out chemotherapy appointments

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SLIDE 21

Financial distress

Non-adherence

Missed appointments

Bankruptcy

Taking fewer medications Selling property

Spending savings

Delaying care

Declining tests

Buying less food

Buying less clothing

Using other people’s medications

Working longer hours

Cutting out vacations

Using credit

Borrowing from friends or family

Replaced prescriptions with

  • ver the counter medications

Spread out chemotherapy appointments

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SLIDE 22

Po lic y

Pro vide r

Pa tie nt

Za fa r SY, JNCI 2015
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MANUF ACT URE RS GOVE RNME NT INSURE RS HE AL T H SYST E MS

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SLIDE 24

MANUF ACT URE RS GOVE RNME NT INSURE RS HE AL T H SYST E MS

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SLIDE 25

OUT COME S- BASE D PRICING

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SLIDE 26

MANUF ACT URE RS GOVE RNME NT INSURE RS HE AL T H SYST E MS

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SLIDE 27
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I n o rde r to pro mo te c o mpe titio n… the Se c re ta ry [o f HHS]:

  • 1. ma y no t inte rfe re with the ne g otia tions

b e twe e n drug ma nufa c ture rs a nd pha rma c ie s a nd PDP spo nso rs; a nd

  • 2. ma y no t re q uire a pa rtic ula r fo rmula ry
  • r institute a pric e struc ture fo r the

re imb urse me nt

  • f c o ve re d pa rt D drug s.
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MANUF ACT URE RS GOVE RNME NT INSURE RS HE AL T H SYST E MS

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MANUF ACT URE RS GOVE RNME NT INSURE RS HE AL T H SYST E MS

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Hig h va lue L

  • w

va lue

Chernew M et al, Health Affairs 2007
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MANUF ACT URE RS GOVE RNME NT INSURE RS HE AL T H SYST E MS

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MANUF ACT URE RS GOVE RNME NT INSURE RS HE AL T H SYST E MS

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SLIDE 34 Pho to : Nic k Ve a se y, T IME , 2013

COST

T RANSPARE NCY

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SLIDE 35

% %

  • f o nc o lo g y sympto m-re la te d

E D visits a re a voida ble

Pa na tto ni e t a l, JOP 2018
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SLIDE 36
  • f c a nc e r pa tie nts

a dmitte d a fte r

pre se nting to E D

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Ca nc e r c a re c osts 6 months from dia g nosis

0% 20% 40% 60% 80% 100%

48% 16%

Bro o ks e t a l, He a lth Aff 2014
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SLIDE 38

E xte nde d- hours urg e nt c a re

Admissio ns ra te fro m E D Admissio ns ra te fro m urg e nt c a re

Ade lso n K , Pe rso na l c o mmunic a tio n
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Po lic y

Pro vide r

Pa tie nt

Za fa r SY, JNCI 2015
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Re duc e fa tig ue Pre ve nt fa tig ue Asse ss fa tig ue

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Re duc e fina nc ia l to xic ity Pre ve nt fina nc ia l to xic ity Asse ss fina nc ia l to xic ity

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Re duc e fina nc ia l to xic ity Pre ve nt fina nc ia l to xic ity Asse ss fina nc ia l to xic ity

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F

  • c us o n

inte rve ntio ns

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Do n’ t use c a nc e r-dire c te d the ra py fo r so lid tumo r pa tie nts with:

  • lo w pe rfo rma nc e sta tus (3 o r 4)
  • no b e ne fit fro m prio r e vide nc e -

b a se d inte rve ntio ns

  • no t e lig ib le fo r a c linic a l tria l
  • no stro ng e vide nc e suppo rting the

c linic a l va lue o f furthe r a nti-c a nc e r tre a tme nt.

ASCO Cho o sing Wise ly
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Go a ls o f c a re

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Re duc e fina nc ia l to xic ity Pre ve nt fina nc ia l to xic ity Asse ss fina nc ia l to xic ity

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“Any re po rt o f the sta tus o f a pa tie nt's he a lth c o nditio n tha t c o me s dire c tly from the

pa tie nt, witho ut inte rpre ta tio n

  • f the pa tie nt's re spo nse b y a

c linic ia n o r a nyo ne e lse .”

Na tio na l Qua lity F
  • rum
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SLIDE 49
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SLIDE 50
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SLIDE 51 Ba sc h e t a l, JAMA 2017

n=766

5 month improve me nt in ove ra ll surviva l

HR 0.83 (95%CI 0.70-.99)

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SLIDE 52

2 4 6

E rib ulin (lipo sa rc o ma ) Ca b o za ntinib (RCC) Ate zo lizuma b (NSCL C) Pe mb ro lizuma b (NSCL C) Nivo luma b (SCCHN) Pa tie nt-re po rte d o utc o me s

Improve me nt in ove ra ll surviva l

Ada pte d fro m K rzyza no wska , ASCO 2017
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SLIDE 53

Re duc e fina nc ia l to xic ity Pre ve nt fina nc ia l to xic ity Asse ss fina nc ia l to xic ity

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SLIDE 54 n=299

%

Za fa r e t a l, AJMC, 2015

de sire a c o st disc ussio n with o nc o lo g ists

%

a c tua lly ha ve a c o st disc ussio n

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No diffic ultie s with c ost Wa nt the be st c a re My doc tor c a n’t he lp T a lke d to some one e lse Not my doc tor ’s job E mba rra sse d

43% 28% 18% 18% 9% 9%

Why didn’t you disc uss c osts?

Za fa r e t a l, AJMC, 2015
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SLIDE 56

n=299

%

re porte d lowe r c osts due to a c ost disc ussion with the ir onc olog ist

Za fa r e t a l, AJMC, 2015
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53% 25% 19% 13% 6%

How we r e c osts de c r e ase d?

Za fa r e t a l, AJMC, 2015

Re fe rre d to fina nc ia l a ssista nc e MD a ppe a le d to insura nc e Switc he d to le ss e xpe nsive me ds Cha ng e d te sts o r de c re a se d fre q ue nc y De c re a se d fre q ue nc y

  • f MD visits
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Me dic ar e Bad De bt

$3.14 b illio n $3.69 b illio n

2012 2016

17% inc r e a se

T ra nsUnio n, 2018
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Pha se I - Re sults

30-pa tie nt fe a sib ility study

83% a g re e d/ stro ng ly a g re e d tha t Bridg e impro ve d

kno wle dg e o f the fina nc ia l a spe c ts o f c a nc e r c a re

72% ma tc he d to a t le a st o ne fina nc ia l a ssista nc e

pro g ra m Me a n o f 4 fina nc ia l a ssista nc e pro g ra m ma tc he s pe r pa tie nt

T ra n e t a l, 2018
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Ca re c o o rdina tio n T ria l e nro llme nt Olde r, sic ke r pa tie nts E vide nc e disse mina tio n E HR’ s Mo le c ula r dia g no stic s Da ta stre a ms

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Ca re c o o rdina tio n T ria l e nro llme nt Olde r, sic ke r pa tie nts E vide nc e disse mina tio n E HR’ s Mo le c ula r dia g no stic s Da ta stre a ms

L e a rning He a lth Syste m

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H

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Co lle c t da ta Ana lyze da ta Cre a te kno wle dg e Cha ng e pra c tic e

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