Three decades of cancer research has produced insights that have dramatically reduced morbidity and mortality for some forms of cancer and has great potential to produce more success (1). The development of targeted approaches to prevent and treat cancer is primarily the result of substantial public investments in basic science and research and development (R&D) in translational clinical trials (2). In the face of high and growing treatment costs (3,4), increasing trial failure rates and spending (5), and local and federal budgetary deficits (6,7) public agencies that fund clinical trials need empirical evidence of the value of these investments to inform innovation and reimbursement policy and systematically identify, prioritize and design future clinical trials (8,9,10,11,12,13). The growth in investment by for-profit biopharmaceutical firms in R&D over the past decades (14) has highlighted the challenge of thoughtful evaluation and planning of the public's resources and the need for a rigorous and systematic evidence base in pursuing future R&D. Economic theory provides a rigorous framework that may aid the translation of advances in basic science into clinical practice (15). Methods have been developed to retrospectively evaluate and prospectively identify, prioritize and design clinical trials (16,17,18,19,20,21). To date, little work has investigated how these methods applied to the unique context of oncology may provide a systematic empirical base for public decision making. My long term research agenda is focused on applying economic methods to address key policy concerns in the financing and organization of oncology clinical trials and practice and ultimately produce practical tools that public decision makers may use to identify and prioritize R&D investments. I am applying for this career development award to afford me the opportunity to gain training in critical areas I require to pursue my long term agenda. The central aspect of my plan is the pursuit of three research projects using advanced economic methods aimed at informing 3 key policy questions. The empirical pursuit of these projects requires focus on specific examples of recent oncology R&D and employs cost benefit analysis, cost-effectiveness analysis, value of information methods and net present value techniques. Although the application of these methods to specific examples cannot definitively answer broad questions, the completion of these projects will prepare me (and hopefully others) for future work aimed at developing a rigorous empirical base for public decision-making in the financing and organization of oncology treatment innovation. I hope that the results of these projects will be of immediate interest to policy making and academic communities. The award is critical to establishing myself as an economist with expertise in the economics of oncology and translational medicine and to producing key results responsive to public policy maker needs.
In the face of high treatment costs, increasing trial failure rates and spending and budgetary deficits, there is significant need for reliable evidence of the value of previous investments and the systematic identification, prioritization and design of future ones. State of the art methods have been developed to do so, but little work has investigated how these methods maybe applied to the unique context of oncology. My long-term agenda is focused on producing practical tools that public decision makers may use to identify and prioritize future R&D investments;this award is critical to establishing myself as an economist with expertise in the economics of oncology and to producing key results responsive to public policy maker needs.
|Goldberg, Paul; Conti, Rena M (2014) Problems with public reporting of cancer quality outcomes data. J Oncol Pract 10:215-8|
|Conti, Rena M; Bach, Peter B (2014) The 340B drug discount program: hospitals generate profits by expanding to reach more affluent communities. Health Aff (Millwood) 33:1786-92|
|Conti, Rena M; Fein, Adam J; Bhatta, Sumita S (2014) National trends in spending on and use of oral oncologics, first quarter 2006 through third quarter 2011. Health Aff (Millwood) 33:1721-7|
|Conti, Rena M; Dusetzina, Stacie B; Herbert, Ann C et al. (2013) The impact of emerging safety and effectiveness evidence on the use of physician-administered drugs: the case of bevacizumab for breast cancer. Med Care 51:622-7|
|Conti, Rena M; Bernstein, Arielle C; Villaflor, Victoria M et al. (2013) Prevalence of off-label use and spending in 2010 among patent-protected chemotherapies in a population-based cohort of medical oncologists. J Clin Oncol 31:1134-9|
|Philipson, Tomas; Eber, Michael; Lakdawalla, Darius N et al. (2012) An analysis of whether higher health care spending in the United States versus Europe is 'worth it' in the case of cancer. Health Aff (Millwood) 31:667-75|