Research at the Center for Health Policy and Outcomes focuses on areas where we see the greatest opportunity for making meaningful improvements to the overall healthcare system, in particular as it relates to the care of cancer patients.
Examining the Cost of Cancer Treatment
Experts say the rising cost of cancer care is emblematic of many problems in the US healthcare system. It is not uncommon for copayments for cancer drugs to drive people into bankruptcy. In addition, some drugs and technologies that are frequently used to treat common cancers provide limited benefits when compared to their high costs. For example, a paper published in the Journal of the American Medical Association by two Center members, Drs. Cami Sima and Katherine Panageas, and Deborah Schrag from the Dana-Farber Cancer Institute demonstrated that a sizable proportion of patients living with advanced cancers continue to receive routine cancer screening tests that are unlikely to provide a meaningful benefit. (1)
Developing an Infrastructure to Improve Cancer Care
Given the range of settings in which people receive cancer care, the huge number of people afflicted with cancer, and the lack of robust data on the quality of care, making widespread improvements to the way cancer care is delivered is a challenge. Improving the quality of care will require, at a minimum, a system that can measure and track changes in the quality of care, can be used at many different kinds of institutions, and captures and reports data in real time. The system must also be reliable enough to be potentially used as a basis for rewards (such as a pay-for-performance system).
Conducting Comparative Effectiveness Research
Different therapeutic and diagnostic approaches for managing cancer have widely disparate prices and side-effect profiles. This situation creates a ripe and challenging area for a field called comparative effectiveness research (CER). CER has the potential to answer important questions for patients, reducing the confusion caused by having multiple treatment options and a lack of information by which to evaluate them. Researchers at MSKCC are also developing and evaluating innovative payment systems that simultaneously promote cost containment and high-quality care. (2)
Taking Advantage of Health Information Technology
Increased funding of health information technology (HIT) is creating the opportunity to make substantive changes to healthcare policy, and ultimately to improve cancer care. From a regulatory perspective, there is a near-term need to define “meaningful use” of HIT in cancer, especially concerning issues of payment and reimbursement. In the long term, HIT could also help to monitor patient outcomes. This step would be necessary for any shift toward a pay-for-performance system.
Addressing Challenges Related to Drug Development
As researchers learn more about the molecular causes of cancer, the field of personalized medicine is getting increasing attention. Personalized medicine is based on a paradigm in which therapies are designed to specifically target the genetic makeup of individual patients and their tumors. Many questions, however, remain to be addressed concerning the development of these targeted therapies and the design of clinical trials to test them. It is important for us to determine the following:
- Best practices for selecting patients for trials of personalized drugs
- The role of prospective randomized trials versus retrospective analyses in the development of these drugs
- The best way to capture patient-reported outcomes and adverse events
- The role of comparative-effectiveness and cost-effectiveness analysis for drug labeling and reimbursement
Focusing on End-of-Life Issues
Although cancer outcomes have improved in recent years, cancer remains the second leading cause of death today in the United States. Given the pace of progress in managing cardiovascular disease, cancer could outpace cardiovascular disease to become the leading cause within the next few years. Because cancer care must focus not only on a cure but also on the prevention of suffering, improving end-of-life care is a priority for the Center for Health Policy and Outcomes.