A recent roundtable discussion at the National Comprehensive Cancer Network’s (NCCN) 20th Annual Conference opened up a discussion on treatment costs and introduced the proposed use of evidence blocks to compare treatments. Currently, the NCCN does not address the issue of treatment costs in their guidelines.

The NCCN’s clinical practice guidelines, which are disease-specific in many cases (including GIST), serve as a reference “standard of care” in the United States, providing guidance to many physicians as to what procedures and treatments to use for particular patients. They are updated at regular intervals (usually every 2 years) so as to incorporate newly discovered tests, treatments, and procedures.

However, in the future, the NCCN will introduce the concept of “affordability” in the guidelines, according to a recent article in Medscape Medical News.

Proposed Use of Evidence Blocks to Compare Treatments

Specific prices of various treatments will not be listed in the guidelines. Instead, they intend to utilize “evidence blocks, graphics in which shaded boxes indicate which treatment is more affordable, effective and tolerable. The concept was introduced by Dr. Robert W. Carlson, Chief Executive Officer of NCCN and Dr. Samuel M. Silver, University of Michigan Comprehensive Cancer Center, who stated that these visual tools will indicate levels of evidence within the NCCN Guidelines based on five elements: efficacy, safety, quality of evidence, consistency of evidence and affordability. Dr. Carlson noted that these evidence blocks would allow physicians to effectively collaborate with their patients to truly identify optimal treatment based on what is most important to the patient.

Joan McClure, who manages guideline development for the NCCN, stated in the article “The evidence blocks will start in systemic therapy sections of guides.”

“Guidelines are not designed for cost reduction, but for quality care, “said Dr. David Ettinger, medical oncologist at Johns Hopkins University, who is the long-time chair of the NCCN panel on NSCLC (non small cell lung cancer). McClure clarified, “Our goal in doing this was not to have drug companies cut their costs.”

It has not yet been announced at what point these criteria will be added, but only that the NCCN intends to incorporate them into future guidelines.

The ramifications for clinical decision-making are unclear at this point, but we will monitor the issue and inform you as they develop.

Pete Knox
Author: Pete Knox