(UroToday.com) The 2023 GU ASCO annual meeting included a session on addressing challenges to ensure health equity in bladder cancer, featuring a presentation by Dr. Cary Stimson discussing value-based care and time toxicity for patients with bladder cancer. With regards to value based care in bladder cancer, Dr. Stimson notes that there are no new ideas, just new facts, and faces. He notes that we have been talking about better ways to deliver health care for more than 70 years and there are only so many ways to do it. Dr. Stimson emphasized that (i) value based care is paying for health care that works, (ii) value based care and bladder cancer have value opportunities, and (iii) where will we go from here is important to understand, as risk is coming. Breaking down value based care, Dr. Stimson notes that “paying” for health “care” that works is important because it includes both how we are compensated for what we do and the care that we provide for our patients. He highlighted that value is defined as outcomes divided by spend (value / spend). The question is, how do we encourage value-based care? According to Dr. Stimson the key is to deploy risk. The following figure depicts what value-based payments may look like, with increasing risk for physicians moving left to right on the figure:
What bladder cancer care is high or low value?
Looking at diagnosis, Dr. Stimson discussed the value of photodynamic TURBT, with his take-away being that this technology did not reduce recurrence, and was not cost effective as compared with white light at 3 years. For staging, Dr. Stimson discussed utilization of PET/CT for patients with bladder cancer, with his take-away being that with the sharp increase in PET/CT utilization, $12 million is being spent based on this type of imaging. For treatment, Dr. Stimson discussed radical cystectomy versus trimodal therapy, noting that the cost of trimodal therapy is higher compared to radical cystectomy at 2- and 5-years. A great example of a high value drug is alvimopan, which shortens time to GI recovery and decreases length of stay after radical cystectomy. Finally, in the treatment space, atezolizumab is not cost-effective compared to cytotoxic chemotherapy as second line therapy for metastatic bladder cancer, therefore does not add value. For surveillance, CellDetect has higher sensitivity and negative predictive value compared to cytology and UroVysion, and thus would be good deemed good value. With regards to the future of value based bladder cancer management, Dr. Stimson notes that CMS is doubling down on bundles in cancer care, but not in bladder cancer.
Dr. Stimson concluded his presentation discussing value-based care and time toxicity for patients with bladder cancer with the following concluding messages, highlighting several points he made at the start of the presentation:
- What is value based care? Paying for health care that works
- Value based care and bladder cancer – there are value opportunities
- Where will we go from here? Risk is coming
Presented by: Cary Stimson, MD, Vanderbilt University Medical Center, Nashville, TN
Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, @zklaassen_md on Twitter during the 2023 Genitourinary (GU) American Society of Clinical Oncology (ASCO) Annual Meeting, San Francisco, Thurs, Feb 16 – Sat, Feb 18, 2023.