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CCAI. ESSENTIAL TO PROGRESS AGAINST CANCER. A National Problem:. Rising h ealth care costs are unsustainable Survival of the U.S. population isn’t any better than countries with much smaller expenditures on health care.

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Ccai

CCAI

ESSENTIAL TO PROGRESS AGAINST CANCER


A national problem

A National Problem:

Risinghealth care costs are unsustainable

Survival of the U.S. population isn’t any better than countries with much smaller expenditures on health care.

Cancer patients sustain greater out of pocket expenses, and more bankruptcies than any other chronic disease.


The high cost of cancer in idaho

The high cost of cancer in Idaho

  • Private insurance spends more on cancer in Idaho than any other disease, and proportionally more than anywhere in the U.S.

  • Can we seize the opportunity to decrease costs while keeping our death rate low?

  • National Vital Statistics Reports, Vol. 61, No. 6, October 10, 2012


What are the ways to improve outcomes in cancer care

What are the ways to improve outcomes in cancer care?

  • Increase value of screening and treatment

  • Increase value of research

  • Increase health through education

  • Increase access to care

  • Increase participation in all of the above


What is the most efficient path to improving health

What is the most efficient path to improving health?

  • Two paths, two different outcomes: England NHS, vs Japan Universal Health Care.

  • Lancet 2011; 378: 1094–105

  • Lancet 2011; 378: 1174–82


Healthy care complex and adaptive

Healthy Care: Complex and Adaptive


Value in health care lessons from complex adaptive system science

Value in Health Care:Lessons from Complex Adaptive System Science

  • Rule 1:The stakeholders agree on a set of mutual, measurable goals for the system.

  • Rule 4:Stakeholder incentives, imperatives, and sanctions are aligned with the agreed-on health system goals.

  • Rule 5:Leaders of all stakeholders endorse, promote, and honor the agreed-on health system goals.

  • Thomas E. Kottke Prev Chronic Dis. 2012; 9: E49.


Maximizing the value of cancer care

Maximizing the Value of Cancer Care

  • Value = Benefit Cost


Defining the value of cancer prevention screening or treatment

Defining the Value of Cancer Prevention,Screening, or Treatment

  • Survival

  • Quality-adjusted survival (QUALY)

  • Quality of life

    • Symptoms of cancer

    • Side effects of treatment

      Cost

  • Toward Patient-Centered Drug Development in Oncology

  • Ethan Basch, M.D. N Engl J Med 2013; 369:397-400


What are the ways to improve outcomes in cancer care1

What are the ways to improve outcomes in cancer care?

  • Increase value of screening and treatment

  • Increase value of research

  • Increase health through education

  • Increase access to care

  • Increase participation in all of the above


Defining the value of cancer trials

Defining the Value of Cancer Trials

  • Transparency

  • Stakeholder involvement

  • Owner of Data

    Cost


Federal approach to cancer research

Federal Approach to Cancer Research

  • Veterans Administration: Started the first multi-institution trials - initially in tuberculosis

  • With this successful model, cancer research cooperative groups formed starting in 1955

  • Co-ops have been successful, and on a shoestring—dozens if not hundreds of trials funded for the same cost as a single randomized pharma trial

  • ASCOPost 5:Issue 5, p 58-59


Threats to federal research

Threats to federal research

  • There has been a 60% reduction in accruals across the country in cooperative studies, due to drop in funding and recent merging of cooperative groups.

  • There are more funding cuts planned in the near future

  • ASCOPost 5:Issue 5, p 58-59


What are the ways to improve outcomes in cancer care2

What are the ways to improve outcomes in cancer care?

  • Increase value of screening and treatment

  • Increase value of research

  • Increase health through education

  • Increase access to care

  • Increase participation in all of the above


Education is likely important to early health

Education is likely important to early health

  • Intensive education starting at a very early age may increase cognition, and educational attainment, but may also independently improve health and healthy behaviors. This has been hypothesized to be extremely cost effective.

  • We need larger studies to confirm these findings, and explore many questions arising from the early studies

  • Am Jrnl Public Health

  • 101: p 512-516, 2011


What are the ways to improve outcomes in cancer care3

What are the ways to improve outcomes in cancer care?

  • Increase value of screening and treatment

  • Increase value of research

  • Increase health through education

  • Increase access to care

  • Increase participation in all of the above


Increased access

Increased access

  • Oregon health insurance experiment showed improved patient reported outcomes. It also showed increased utilization of primary care, preventive care, hospitalizations and emergency rooms

  • Q J Econ 2012; 127:1057-106

  • Science 2014; 343:263


The value of preventing disparities in delivery

The Value of Preventing Disparities in Delivery

  • Those likely to find cost a barrier to care are minorities

  • Minorities, although they have a lower rate of breast cancer, are affected at a younger age

  • Curing cancer at a younger age has greater value

  • Olufunmilayo Olopade, Examining the role Genetics Plays in Breast Cancer Onset. ASCOPost July 25, 2013.


What is the best way to address the issue of disparities in idaho

What is the best way to address the issue of disparities in Idaho?

  • Will the Oregon Health Experiment tell us if outcomes in cancer will be better with expanded Medicaid coverage?

  • Or will other barriers be larger in Idaho?

  • N Engl J Med 2013;368:1713-22.

  • Science 2014; 343: 263-268

  • Am J Manag Care. 2012;18(5 Spec No. 2):SP65-SP70)

  • Social Science & Medicine 2008; 67, Issue 10, 1604–1611

  • http://nihrecord.od.nih.gov/newsletters/2011/11_11_2011/story4.htm


The value of eliminating disparities in care

The value of eliminating disparities in care

  • $77 billion annually in direct costs nationwide.

  • http://www.jointcenter.org/hpi/sites/all/files/Burden_Of_Health_FINAL_0.pdf


What are the ways to improve outcomes in cancer care4

What are the ways to improve outcomes in cancer care?

  • Increase value of screening and treatment

  • Increase value of research

  • Increase health through education

  • Increase access to care

  • Increase participation in all of the above


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