Assessment of value for resource allocation in cancer care

There has been an increased interest in ways of measuring the value of new therapeutic options in oncology. An example of this in a European context is the ESMO Magnitude of Clinical Benefit Scale (ESMO-MCBS). The purpose of this study is to analyse how the value scales, exemplified with ESMO-MCBS, developed mainly to assist decisions by physicians, relate to other measures of clinical benefit and value used by reimbursement agencies.We undertook a comparison of ESMO-MCBS with three different approaches to measure value; the patient benefit scale (AMNOG) used in in Germany, the assessment of ASMR (Amélioration du Service MédicalRendu) used in France and estimates of gain in quality adjusted life years (QALY) used in several countries such England and Wales, Scotland and Sweden. The criteria and metrics, as well as the purpose and decision making processes differs between the agencies, which makes it possible to study both differences and similarities between the three different approaches compared to the ESMO-MCBS value framework. Correlations between the scales were formally tested using the Spearmans rank test.There was reasonable agreement between ESMO-MCBS and the AMNOG. Although there was a statistically significant correlation between the scale and ASMR scores overall there is very little agreement between the two categories in the middle of the scale. The link between ESMO-MCBS and QALYs appears to be very weak with very little differentiation between drugs receiving a ESMO-MCBS of 2, 3 or 4.