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Competing-Risk Nomogram for Predicting Cancer-Specific Survival in Multiple Primary Colorectal Cancer Patients after Surgery

Competing-Risk Nomogram for Predicting Cancer-Specific Survival in Multiple Primary Colorectal Cancer Patients after Surgery

Published on: September 27, 2024

Colorectal cancer: complexities and challenges in managed care.

Neil B Minkoff¹

¹Network Services and Pharmacy, Harvard Pilgrim Health Care, Wellesley, Massachusetts 02481, USA. neil_minkoff@hphc.org

Journal of Managed Care Pharmacy : JMCP

|October 13, 2007

Summary

Managed care faces challenges in evaluating the value of expensive cancer therapies. New reimbursement models and limited data for novel oncology drugs complicate treatment decisions.

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Area of Science:

Oncology
Health Economics
Managed Care

Background:

Managed care organizations (MCOs) assess treatment value by balancing advances in care against costs.
The price of medical treatment is a significant but not sole determinant of value.

Purpose of the Study:

To review the processes governing treatment decisions for oncologic agents within managed care settings.
To examine the impact of evolving reimbursement policies on cancer care.

Main Methods:

Review of treatment decision-making frameworks in managed care.
Analysis of current and proposed reimbursement strategies for oncology drugs.
Examination of challenges faced by pharmacy and therapeutics committees.

Main Results:

Cancer therapies, particularly novel agents, present unique challenges for managed care due to high individual costs and potential population-level impact.
Shifting Medicare reimbursement from Average Wholesale Price (AWP) to Average Sales Price (ASP) plus 6% creates significant issues for oncologists and practices.
Expedited drug approval pathways result in limited data for some oncology agents, complicating formulary decisions.

Conclusions:

Oncology disease management should address patient-centric needs beyond direct cancer treatment, including pain and depression.
Managed care must adapt evaluation and reimbursement strategies for high-cost, novel cancer therapies.
Interdisciplinary approaches are crucial for optimizing cancer care within managed care environments.