How to create value with constrained budgets in oncological care? A narrative review.

We state that value holds many different aspects. For reimbursement decisions, we argue that it is simply not feasible to incorporate all patient values because of the need for efficient resource allocation. We argue that we should shift the value debate from the individual perspective of patients to creating value for the cancer population at large. The different strategies we address are: 1) shared decision-making, 2) biomarkers and molecular diagnostics, 3) appropriate evaluation, payment and use of drugs, 4) supportive care, 5) cancer prevention and screening, 6) monitoring late effect, 7) concentration of care and oncological networking, and 8) management of co-morbidities. Important preconditions to support these strategies are strategic planning, consistent cancer policies and data availability.