What value cancer treatments? A mixed methods approach to designing a novel value framework for oncology

Background: A number of frameworks for assessing the value of cancer treatments have been developed to help address the rising cost of cancer treatments. The National Comprehensive Cancer Network’s evidence blocks, Memorial Sloan Kettering Cancer Center’s Drug Abacus and ASCO’s value framework are examples. However, the justification for the differing attributes included in these frameworks is unclear. This mixed methods study aims to identify, measure and value key attributes prioritized by different stakeholders in the US for inclusion in a new oncology value framework.

Methods: A scoping literature review identified attributes currently included in existing value frameworks. Nominal Group Technique (NGT) methods were then used in 3 focus groups in New York, USA representing cancer patients, oncology nurses, and physicians across a range of cancer specialties to identify the ‘top 6’ factors (or attributes). These attributes informed the design of a discrete choice experiment (DCE) to develop a new preference-based value framework for cancer treatments.

Results: NGT methods identified twenty-one ‘attributes’ from the patient (n=8), nurse (n=10) and physician (n=6) focus groups. All prioritised efficacy and safety/toxicity. Long-term adverse effects, alternative treatment options, quality of evidence and reputation of the treating oncologist/centre were prioritized by patients. Nurse preferences centred on mode of administration (including staff safety implications), quality of life, communication and treatment innovation. Physicians focused on the burden and inconvenience of treatments to patients, functional outcomes, financial toxicity to patients, and wider societal costs. These attributes have informed the design of a DCE to value and weight attributes for inclusion in a value framework for cancer treatments.