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H expenditures in the United States are mounting at near double the rate of the consumer price index, with drug costs increasing faster than other contributors.1 The cost of most new anticancer therapies exceeds $10,000 per month, regardless of whether there are competing drugs of the same class or for the same indication.2 New market entrants have neither curbed rising costs nor led to improved outcomes for patients in the United States compared with other industrialized nations.3 This disconnect between higher prices, increased competition, and limited clinical benefits has challenged the historical basis for measuring value of cancer drugs using the parameters of efficacy and toxicity (safety) rather than quality and cost. Today, value is more often defined as the balance between desired patient outcomes and the costs incurred to achieve these outcomes.4 More than a decade ago, the Institute of Medicine (IOM) challenged the notion of a 2-parameter basis for value in healthcare by establishing 6 core components.5 Professional societies and advocacy groups have inconsistently adopted the IOM definitions as they developed value-assessment frameworks in an attempt to improve shared decision-making.6 The ASCO Value Framework,7 NCCN Evidence Blocks,8 ESMO Magnitude of Clinical Benefit Scale (MCBS),9 and the Institute for Clinical and Economic Review (ICER)10 are examples of how large organizations are tackling the value-based healthcare debate. As the dialogue progresses, it is becoming increasingly apparent that various stakeholders see value through very different prisms. We assess how value perspectives for cancer drugs differ among the stakeholders (payers, manufacturers, providers, patients) and propose an approach based on a unifying value principle espoused by all stakeholders: administer the right drug to the right patient at the right time.

Value in Oncology: It Is in the Eyes of the Beholder