Healthcare value has been defined as outcomes divided by costs, but it's not always that simple, especially in treating patients with cancer, explained Stuart L. Goldberg, MD, Chief, Division of Outcomes and Value-Based Care at the John Theurer Cancer Center and associate professor of medicine at Seton Hall School of Medicine.
We know that value has been defined by the medical oncologists as outcomes divided by cost, but in oncology, how do we define outcomes? Is it overall survival, is it the quality of the survival, is it progression-free survival? And how do we define costs? Is it costs to the government, to the insurer? Is it the out-of-pocket costs to the patient? Many of these actually conflict with each other.
We've had patients who have asked to not be put in the hospital because it comes with major medical [expenses], whereas it's cheaper if we give them outpatient therapy. Or, we go from generics, which are cheaper for the insurance company but there may not be a co-pay assistance [program] for our patients.
So there's a lot of conflicts in defining what is value and how to fix our patients. But then when we get down to the nitty gritty of our patients, we know that patients who have cancer spend a lot of money over $5,000 to $10,000 depending on the disease. [For] the hematologic malignancies, some of them have [according to] recent reports from the Leukemia & Lymphoma Society said if you have insurance, lymphoma diagnosis costs you over $6,000 to $7,000. And if you have one of the "short plans," over $20,000 to $40,000 is what out-of-pocket [costs] comes to for our patients. This affects quality of life, what they can do, and it puts them at risk for financial toxicity.
We know that the cancer patient is twice as often going to file for bankruptcy, and if they file for bankruptcy, their survival goes down. So what can we do about it, and how does it affect the patients? Well we don't really know because most of us are never asking our patients. We're required under Medicare and other government plans to ask our patients at every visit if they have pain. But when was the last time you asked a patient, "Are you able to pay the bills?"