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VALUE PROPOSITIONS Practices Are Merging to Cut Costs, Increase Quality: The Future of Cancer Care?
Targeting Tumor’s Environment a Cost-Effective Approach to Drug Development
Diablo Valley Oncology and Pacific Urology—2 of Contra Costa County, CA, largest private specialty practices—are merging forces to form the first oncology–urology multispecialty practice in their area. Responding to the impending cuts in Medicare to providers, the 2 practices have “concluded that combining our practices secures the future for both organizations and consequently the quality of care of our patients,” said Matthew Sirott, president and CEO of Diablo Valley Oncology. “In the end, it’s a win–win for us and our patients. Now we’ll be able to see more patients in more locations, reduce overhead expenses, and collaborate more closely than ever” (www.pacificurology.com/merger-announcement; November 11, 2011).
Some drug makers are shifting their focus from cancer cells to the tumor’s entire environment, including the surrounding blood vessels, proteins, and molecules as a way to inhibit tumor growth. Specifically, 3 companies in Cambridge, MA, are focusing their efforts on targeting the tumor’s environment rather than on cancer cells to kill cancer: • Infinity Pharmaceuticals is testing a drug for pancreatic cancer that disrupts the microenvironment of the tumor by depleting the protective tissue around it and allowing chemotherapy to reach the cancer cells more easily. • Pervasis Therapeutics is experimenting with embedding healthy blood vessel cells into an implant inside the tumor, which resulted in the inhibition of tumor growth in mice. • Axios Biosciences is creating diagnostic tools to enable more accurate drug testing and screening by including the tumor’s environment in the screening. This approach reflects the realization that the normal cells in the healthy environment of the tumor may have something to do with the disease itself, and therefore studying the tumor’s environment may lead to a cost-effective approach to killing tumors (New York Times, November 14, 2011).
Greater Role of NPs/PAs in Oncology Increases Practice Productivity A study published in the Journal of Oncology Practice (September 15, 2011) suggests that increasing the roles of nurse practitioners (NPs) and physician assistants (PAs) is an effective way to deal with the projected workforce shortages in oncology. The study showed that practices in which the roles of these 2 groups are expanded to work more independently with patients and with all practice physicians are 19% more productive than those in which NPs and PAs are assigned to specific physicians or do not see patients independently.
New Phenotypic Screening Platform Improves Drug Development, Reduces Cost, Time At the November 12-16, 2011, American Association for Cancer Research Molecular Targets and Cancer Therapeutics meeting, National Cancer Institute (NCI) scientists revealed a new phenotypic, cell-specific platform to evaluate the effectiveness of angiogenesis inhibitors. “This platform allows us to predict what’s going to happen in preclinical models,” said Enrique Zudaire, PhD, radiation oncology scientist at NCI. “This not only shortens the amount of time that you would need to do screenings and drug discovery, but also enhances dramatically the success you are going to have in the next phases.” Unlike past research, which focused on single molecular targets for angiogenesis inhibitors, this new platform examines the way angiogenic inhibitors simultaneously act on the entire angiogenesis process. This can reduce early-phase failure rate, by targeting not only one potential enzyme but the way the enzyme works in a complex organization that could lead to several drug options, which increases the chance for success. Using this approach has helped identify more than 100 key compounds, all of which demonstrated antitumor activity; some blocked tumor growth more effectively than currently available angiogenesis inhibitors. By improving the “initial phases of drug discovery, we can decide where to invest time and money on drugs that are a lot more likely to work,” said Dr Zudaire.
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IOM’s Report on Essential Health Benefits: Balancing Cost and Coverage On October 6, 2011, the Institute of Medicine (IOM) released its consensus statement on what constitutes essential health benefits (EHBs), as mandated by the Affordable Care Act (ACA) of 2010. This “package”of benefits constitutes the minimum set of benefits that health plans must cover under the ACA, although insurers may opt to offer additional benefits. The IOM statement notes that the committee recognized 2 competing goals: “to provide health insurance coverage for a wide range of health needs and to make it affordable” (www.iom.edu/reports/2011/essential-health-benefits-coveragebalancing-coverage-and-cost). The committee further states that “keeping the EHB affordable is necessary for consumers, employers, and taxpayers.” The committee concludes: “Unless we are able to balance the cost with the breadth of benefits covered in the EHB, we may never achieve the health care coverage envisioned in the ACA. If the benefits are not affordable, fewer individuals will buy insurance. If accessing benefits is too difficult, people will not get the care that they need. And if health care spending continues to rise so rapidly, the benefits covered under the EHB will begin to erode, eventually resulting in minimal coverage for the people who need it most.”
ACCC Launches Workbook to Assess Value of Hospital Oncolytics The Association of Community Cancer Centers (ACCC) has launched a new workbook—The Practical Cancer Pharmacy Workbook—to provide hospital cancer program pharmacy and financial teams a practical tool to assess the pharmacoeconomics of cancer drug therapies used in hospitals, “which explores the relationship between costs of healthcare interventions and the outcomes they produce” and to assess the “value associated with drugbased therapy” (ACCC press release, September 1, 2011).
www.ValueBasedCancerCare.com
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