The increasing availability of innovative health care technologies for the treatment of cancer and the substantial expense of some of these technologies are driving the need for a more explicit comparison of therapeutic options for specific clinical indications. Major constituencies, including legislators and policy makers, are calling for the application of comparative effectiveness (CE) analysis in developing clinical policy. CE research (CER) has emerged as a priority concept as part of the larger health care reform agenda.
In order to address the issue of comparative effectiveness in oncology, NCCN formed an Oncology Comparative Effectiveness (OCE) Work Group. The OCE Work Group consisted of 16 members representing such stakeholder groups as patient advocacy, managed care, and industry along with eight physicians from NCCN member institutes. The OCE Work Group provided recommendations for development of a strategy for incorporating comparative effectiveness research (CER) into the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) process through the use of the NCCN Comparative Therapeutic Index (CTI) that will be employed to compare different treatment options.
The OCE Work Group met throughout 2009 to discuss the NCCN staff’s efforts towards developing the CTI. A draft white paper was posted at NCCN.org for public comment and was presented at the NCCN Oncology Summit: Comparative Effectiveness in Cancer Care on December 7, 2009 in Washington, D.C. Along with the NCCN presentation of the CTI, a roundtable discussion was held on the efforts towards incorporating CER into oncology and the use of the CTI. NCCN took the feedback and discussion from the NCCN Oncology Summit to further modify and improve the NCCN Comparative Therapeutic Index. A Preliminary Report: The Development of the NCCN Comparative Therapeutic Index™ as a Clinical Evaluative Process for Existing Data in Oncology has been published as a supplement to the September 2010 issue of JNCCN.
Before this paradigm can be incorporated into the NCCN Guideline process, proper vetting is required in terms of an adequate assessment of the reliability and validity of the scoring scales. Applying methodologic principles to assess these issues will require pilot testing of the CTI (i.e., the results obtained during the pilot would not be incorporated into the NCCN Guidelines). NCCN is in the process of completing these assessments towards finalization of an NCCN CE analytic paradigm.
Work Group Members