Value, Access, and High-Quality Medical Oncology Care: Can We Have It All?

Health systems, oncologists, and patients face a crisis in value of cancer care that has several components: interpretation of meaningful benefit, cost, and affordability that limits access to treatment and effective delivery of evidence-based care. Value in health care has several definitions but can be defined as benefit/cost, which can be explicitly measured using cost-effectiveness analyses and used to shape coverage decisions for health systems. In addition to drug costs, costs can also include physical costs (ie, clinical toxicities and harm), productivity losses (from inability to work because of treatment effects), and time away from family and friends. Low-value treatments include those that offer limited clinical benefit and score poorly on scales such as the European Society of Medical Oncology Magnitude of Clinical Benefit Scale and the overuse, misuse, or underuse of therapies that provide clinical benefit. Opportunity costs are what is given up when one intervention is chosen over another. Opportunity costs of low-value care translate into patient and societal harm and limit access to more effective treatments. Solutions to the value crisis require recognition of low-value care and quality improvement programs to prevent its use and support high-level care. Drug substitution and dose and schedule reduction when supported by evidence can also improve the value of care.