Researchers consider value-of-information theory for selecting trials.

O ncology faces a dilemma with newer cancer drugs that are both too expensive and not effective enough, according to critics. Now some researchers and economists say that there’s a way to address that problem while drugs are still in the pipeline. Called value-of-information (VOI) theory, it can be used when deciding which clinical trials to fund, according to Larry Baker, D.O., a professor of internal medicine at the University of Michigan Medical School, Ann Arbor. Baker chairs the Southwest Oncology Group (SWOG), one of the large National Cancer Institute – sponsored clinical trial cooperative groups. Rather than basing funding selections on expert opinion, gathered during roundtable reviewer discussions, Baker hopes to use what he says is a more rigorous process grounded in VOI theory. VOI, he said, will ideally force those designing trials to aim for wider effect differences between treatment and control groups. At the same time, it will make the selection process less vulnerable to visceral reviewer reactions, poor communication, and a tendency to defi ne minor treatment gains as acceptable, he said. “We’re looking for more signifi cant clinical payoffs,” he said. The VOI approach was presented at the last meeting of SWOG’s advisory board, with a supportive response, according to Baker. “We’ll be holding a retreat with our leadership in February, with an aim to get their endorsement,” he added. And an R01 grant application to develop the approach has been submitted to the NCI, he said, with Scott Ramsey, M.D., Ph.D., of the Fred Hutchinson Cancer Research Center in Seattle, as principal investigator.