Appropriate Use of Advanced Technologies for Radiation Therapy and Surgery in Oncology. July 20-21, Washington DC
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1 Appropriate Use of Advanced Technologies for Radiation Therapy and Surgery in Oncology July 20-21, Washington DC
2 OVERVIEW Ya-Chen Tina Shih, PhD Professor and Section Chief Section of Cancer Economics and Policy Department of Health Services Research University of Texas MD Anderson Cancer Center
3 NCPF s Long Term Interests in Value Motivation: Exceedingly high cost of new cancer treatments Unsustainable increase in the cost of cancer care Substantial financial burden to patients and their families An aging society, with age being a prominent risk factor for cancer
4 New Technology and Value Discussions New technology often takes the center stage of value discussions Almost always cost more May or may not lead to better health outcomes Utilization influenced by nonclinical factor: Provider-induced demand Consumer-induced supply Goal: to find the best treatments that are affordable to patients and healthcare system through appropriate use of advanced technologies
5 Assessing and Improving Value in Cancer Care October 2009
6 Delivering Affordable Cancer Care in the 21st Century October 2012
7 IOM Report on Quality of Cancer Care September 2013
8 Ensuring Patient Access to Affordable Cancer Drugs June 2014
9 Why Today s Workshop? Important differences between drugs and devices Proliferation of devices Fast uptake Financial consequences
10 Drugs vs. Devices for Oncology Care Drugs Devices Clinical trials for approval X Post-marketing surveillance Price set by manufacturers? Patent protection & generic entry X Off-label use? Capital investment X Payment innovation tiered-formulary bundle payment pathway guideline bundle payment
11 Why Today s Workshop? Important difference between drugs and devices Proliferation of devices Fast uptake of new technologies Financial consequences
12 Da Vinci Surgical System U.S. Installed Base
13 Da Vinci Surgical System U.S. Installed Base
14 Da Vinci Surgical System U.S. Installed Base
15 2008 Da Vinci Surgical System U.S. Installed Base 2008
16 Da Vinci Surgical System U.S. Installed Base 2015 > 2200
17 Why Today s Workshop? Important difference between drugs and devices Proliferation of devices Fast uptake of new technologies Financial consequences
18 Fast Diffusion of New Technology Minimally Invasive RP Breast Brachytherapy 100% 95.54% 80% 60% 49.71% 40% 48.46% 20% 5.28% 0% 0.00% 0.00% 0.00% PRP RRP R-LRP Shih et al. Value in Health 2012 Smith et al. JCO 2011
19 Why Today s Workshop? Important difference between drugs and devices Proliferation of devices Fast uptake of new technologies Financial consequences
20 Financial Consequences Use of robotic surgery increases the cost of surgery by 13% (1) Radiation oncology has the highest excess growth in Medicare among all specialties (2) Sources: (1) Barbash and Glied, NEJM 2010; (2) Alhassani et al NEJM 2012
21 Workshop Agenda Session 1A/B: science and comparative effectiveness Session 2A/B: from discovery to marketplace Session 3A/B: assess value and define optimal use
22 Planning Committee Ralph Weichselbaum (co-chair), U Chicago Monica Bertagnolli, Harvard/Dana-Farber Otis Brawley, ACS Robert Carlson, NCCN Patricia Ganz, UCLA Carol Hahn, Duke Lori Hoffman Hōgg, Office of Nursing Services Jim Hu, Cornell Ted Lawrence, U Michigan Steve Piantadosi, Cedars-Sinai Medical Center
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