Transcript Value in Cancer Care

Value in Cancer Care
Renato G Martins
Stephen H. Petersdorf Endowed Chair in Cancer Care
Medical Director
Thoracic/Head and Neck Medical Oncology
Professor
University of Washington
How Do We Choose Health Care?
Case
• A friend of the family develops a cough which
does not get better and after 2 weeks he
goes to see his primary care physician
• A chest x-ray is performed
Case
• He is placed on antibiotics and symptoms
improve but his PCP asks him to come back
to document that the chest x-ray returned to
normal
Case
• He is placed on antibiotics and symptoms
improve but his PCP asks him to come back
to document that the chest x-ray returned to
normal
• A CT scan is performed
Case
• He is placed on antibiotics and symptoms
improve but his PCP asks him to come back
to document that the chest x-ray returned to
normal
• A CT scan is performed
• A CT guided biopsy shows adenocarcinoma
of the lung
If he asked you how he should decide
where to be treated you would suggest:
• Ask the PCP and follow his recommendation
• You heard on the radio that a hospital in town
has a lung cancer center and he should go there
• You have a cousin who had surgery for lung
cancer at hospital X and he really liked it
• You have a friend who is a diabetes doctor and
you will ask him for the best place
The first important question is:
Does it matter?
Are outcomes so similar that one
can get therapy anywhere?
Perhaps good parking should be a
factor? 
Surgery by Whom?
44%
p<0.0001
36%
Bach P et al. N Engl J Med 2001;345:181-188
Is the care itself very similar?
Hutchinson Institute for Cancer Outcomes
Research (HICOR): WA State Data
Hutchinson Institute for Cancer Outcomes
Research (HICOR): WA State Data
Early Palliative Care
Aggressive care( chemotherapy last 14 days
before death; no hospice care; admission to
hospice 3 days or less before death): 54% in the
standard of care arm and 33% in the early
palliative care arm
Temel JS, Greer JA, Muzikansky A. et al. N Engl J Med;363:733-42.
Regional Average: 22.8%
Seattle Cancer Care Alliance:
Office of Quality, Safety and Value
END OF LIFE CARE METRICS
Month
Chemo in last 14 days of life
Yes
Sep-14
Aug-14
Jul-14
Jun-14
May-14
Apr-14
Mar-14
Feb-14
Jan-14
Dec-13
Nov-13
Oct-13
Sep-13
Aug-13
Jul-13
# of Deaths
ER Visits in the last 30 days of life
% of Yes
Yes
# of Deaths
ICU Deaths
% of Yes
Yes
# of Deaths
% of Yes
4
47
8.5%
7
47
14.9%
2
47
4.3%
3
47
6.4%
13
47
27.7%
7
47
14.9%
6
80
7.5%
17
80
21.3%
11
80
13.8%
6
67
9.0%
20
67
29.9%
7
67
10.4%
5
76
6.6%
12
76
15.8%
5
76
6.6%
4
65
6.2%
14
65
21.5%
3
65
4.6%
3
68
4.4%
15
68
22.1%
4
68
5.9%
7
73
9.6%
15
73
20.5%
3
73
4.1%
5
82
6.1%
15
82
18.3%
5
82
6.1%
8
82
9.8%
15
82
18.3%
5
82
6.1%
7
70
10.0%
17
70
24.3%
6
70
8.6%
4
76
5.3%
18
76
23.7%
4
76
5.3%
6
78
7.7%
14
78
17.9%
4
78
5.1%
7
73
9.6%
18
73
24.7%
6
73
8.2%
4
88
4.5%
9
88
10.2%
9
88
10.2%
79
1072
7.4%
219
1072
20.4%
81
1072
7.6%
What information do we need to
choose the right place?
Is the Ferrari 458 a better value?
Is the performance 9 times better?
Is the interior 9 times more comfortable?
Is it 9 times safer?
9 times more reliable?
Value in Health Care
• Value in Health Care: Health Outcome/dollar of
cost expended
• “Mandatory measurement and reporting of
results is perhaps the single most important step
in reforming the health care system.”
Redefining Health Care. Michael E. Porter and Elizabeth O. Teisberg . Harvard Business Review Press
2006
• Results: Those that matter to patients and are
based on specific medical conditions
International Consortium for Health
Outcomes Measurement (ICHOM)
• “ICHOM’s mission is to unlock the potential of
value-based health care by defining global
Standard Sets of outcome measures that really
matter to patients”
Defining Health Outcomes
• Bring together patients who received treatment
for the condition and leading physicians from
across the globe
International Consortium for Health Outcomes
Measurement (ICHOM): Lung Cancer
ICHOM: Lung Cancer (cont)
Cancer Cost: NIH Projections in 2011
• Expected to reach $158 billion dollars in 2020, an increase of 27%
over 2010
• 2010: breast cancer ($16.5 billion); colorectal Cancer ($14 billion);
lymphoma ( $ 12 billion); lung cancer ($12 billion); prostate cancer
($12 billion)
http://www.cancer.gov/newscenter/newsfromn
ci/2011/CostCancer2020
Cost of Care Can Vary
Substantially!
Value equation: Cost (HICOR data)
2-29-2012
4-29-2015
August 2015: Completed the 150 mile
fundraiser bike ride for the FHCRC
Back to your friend…. Just imagine if
he knew:
• For lung cancer surgery, hospital X has an in-hospital
mortality of 2% while in hospital Y this number is 4%
• The 5 year survival of patients operated for lung cancer is
55% in hospital X and 51% in hospital Y
• Thirty days after lung cancer surgery, 90% of patients are
free of pain medication while in hospital Y this number is
80%
• The median cost of lung cancer surgery (and post-op
care) in hospital X is $38,000 while in hospital Y it is
$41,000
Conclusions
• The Health Care “Market” is very imperfect
• Consumers do not have access to the
information to make an informed decision
• This is changing and that is VERY good
news to patients
Thank you!
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