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Chadi Nabhan and Bruce A. Feinberg

recognizes limitations of conducting expensive confirmatory randomized studies for every indication in every disease stage. 4 Behavioral economics is a discipline that combines insights from psychology, economics, judgment, and decision-making to better

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Jonas A. de Souza, Mark J. Ratain, and A. Mark Fendrick

When everyone is required to pay the same out-of-pocket amount for oncology services for which benefits depend on patient characteristics and clinical indication, there is enormous potential for both under- and overutilization. Unlike most current health plan designs, the value-based insurance design (V-BID) explicitly acknowledges and responds to patient heterogeneity across the entire continuum of cancer care. By adding “clinical nuance” to benefit design, V-BID encourages the use of services when the clinical benefits exceed the cost, and likewise discourages the use of services when the benefits do not justify the expenditure. This manuscript further describes the concept of V-BID, creates a framework for its development in oncology, and outlines how this concept aligns with ongoing research, care delivery, and payment reform initiatives.

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Charles R. Handorf

attain in the fragmented and often bewildering health care system. A comprehensive review of health care economics and how they affect the disadvantaged is far beyond the range of this article; however, one comment can be made. If effective and efficient

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David C. Hohn

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Joan S. McClure

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William J. Ellis and Paul H. Lange

M Lange PH . Two-year outcome of unilateral sural nerve interposition graft after radical prostatectomy . Urology 200 ; 68 : 1290 – 1294 . 9. Lotan Y Cadeddu JA Gettman MT . The new economics of radical prostatectomy: cost comparison

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Gary H. Lyman and Jessica Malone Kleiner

chemotherapy . J Natl Cancer Inst 1993 ; 85 : 488 – 493 . 17. Lyman GH Kuderer N Greene J Balducci L . The economics of febrile neutropenia: implications for the use of colony-stimulating factors . Eur J Cancer 1998 ; 34 : 1857 – 1864

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Margaret Tempero

for a common service in any medical practice would be a difficult pill to swallow. Putting the economics aside, one has to question why CMS would devalue such an important procedure as colonoscopy. The decline in both the incidence and mortality