Dr. Mark Fendrick: How expensive therapies fit into VBID for oncology

January 29, 2018

Dr. Mark Fendrick: How expensive therapies fit into VBID for oncology

American Journal of Managed Care

When a drug becomes first-line, I would like to think that as a clinician I would have access to that, but most importantly that my patients would not have to have a bake sale or take out a second mortgage on their homes to get therapies that are designed specifically for them, said IHPI member A. Mark Fendrick, MD, director of the Center for Value-Based Insurance Design at U-M.

I like to tell audiences that what worries me the most is we have Star Wars science and innovation, and we have Flintstones delivery. I think we’re really trying hard to be able to have the delivery system catch up to the innovation. I believe that people in health policy tend to care more about healthcare cost and healthcare cost growth than understanding what the potential impact might be on individual and population health if we deliver care in a more appropriate way. So, 1 is that I’m incredibly excited about the fact that now we can have therapies derived from an individual patient’s cells to treat their own cancers, understanding though that immediately the media is not about the clinical benefits which come with that, but the $450,000 price tag or the $1 million price tag, or the $2 million price tag.

So, understanding that we have to balance both clinical benefit and cost. We can’t give everything to everyone in all circumstances, and that’s where value-based insurance design comes in. I think that when a drug becomes first-line, whether it be immediately because you have such a targeted situation, or you’ve taken 2, 3, maybe even 4 lower cost drugs and now you end up in these high cost or precision therapies, it is my opinion as a clinician that when I deem a therapy to be first-line, which may be day 1 or day 1,000, and it may be therapy 1 or it may be therapy 6, but in that day when it is my first-line or the best therapy for the patient, I would like to think that I as a clinician would have access to that, but most importantly that my patients would not have to have a bake sale or take out a second mortgage on their homes to get therapies that are designed specifically for them.

I understand that there’s great tension; I’m not sure that we’ll get the answer right away. But, the more we understand that there thankfully is a lot of waste in the system, that if we were to identify and remove some of that, would give us some headway moving forward to allow us to pay for innovation moving forward and not be in that crunch situation where a public or private payer says, “If you don’t give me a dollar back, in a hospitalization or ER visit avoided, I’m not going to approve this therapy for use.”

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