Dr. Israel was able to share her experience in value framework in oncology with the bladder cancer community. The idea behind value framework from ASCO is focus is to support informed, shared decision making between doctor and patient. Its goal is to develop and employ a tool that can customize information for each patient, and to remind the physician that the primary responsibility is the patient.
Elements considered when developing framework are: clinical benefit, toxicity, cost, universal access, lost wages and patient satisfaction. Their framework includes a primary focus on overall survival, then progression free survival and lastly recurrence free survival, in decreasing order, with a focus on extended survival off therapy. It considers toxicity with symptom palliation and quality of life, and lastly cost to the patient and system. His clinical benefit calculator will help quantify overall value in discussion with patients. Dr. Schnipper discusses other Frameworks, the ESMO, NCCN evidence blocks, ICER, and Drug Abacus. Each have different parameters and scope. Threshold for value however, is to be determined and is patient and disease state specific.
Next steps in value framework for bladder cancer is to determine how to incorporate the value of agents regimens into clinical pathways. The final steps will help create a patient cantered approach to bladder cancer care.