Use of ESMO-MCBS Scorecards in supporting funding decisions in private insurance

BackgroundWith the emergence of novel cancer therapies, there is a lack of guidance to assist with decision making around who would benefit most from them. In 2015, the European Society for Medical Oncology (ESMO) launched the ESMO-Magnitude of Clinical Benefit Scale (ESMO-MCBS) to facilitate improved decision-making regarding the value of new therapies, with scorecards ranging from 1 (low) to 5 (high). Bupa is a large UK insurer. The Bupa out of licence process (OOL) assesses the clinical benefit of drugs off label to decide whether treatments should be funded in line with Bupa policy. Where there is lack of evidence, OOL requests are escalated to a Medical Director (MD).MethodsWe retrospectively looked at MD-escalated OOL requests for solid tumours from Oct 2022 to Oct 2023. For each we searched the ESMO-MCBS database. Where there was a Scorecard available we compared the score with the MD’s decision to assess if routine use of the ESMO-MCBS Scorecard could be useful in supporting decision making in complex cases.ResultsA total of 89 cases met the criteria, all metastatic, advanced, progressive or recurrent. The most common tumour types were glioblastoma (n=22), breast (n=10), colorectal (n=8) and prostate (n=7). Twelve percent (n=11) were declined for funding. Of these, 27% (n=3) were for drug-condition pairings that would have scored 1-3 as per the Scorecard, with the remainder having no applicable Scorecard. There were no cases scoring 4-5 that were declined. Seventy percent of total cases (n=61) did not have an applicable scorecard on the ESMO-MCBS database.ConclusionsWhere there is a scorecard, the ESMO-MCBS scoring system could be a useful tool to support OOL decision making. However, complex cases escalated to MD level are less likely covered by the MCBS database. With the increasing use of maintenance palliative therapies, it may be useful for ESMO to expand scorecards to cover more of these scenarios.Legal entity responsible for the studyThe authors.FundingBupa.DisclosureS. Field: Non-Financial Interests, Institutional, Full or part-time Employment: Bupa. T.J. Woodman: Financial Interests, Institutional, Full or part-time Employment: Bupa. C. Mikropoulos: Financial Interests, Institutional, Full or part-time Employment: Bupa; Financial Interests, Institutional, Funding: Bayer.