Novel Approaches to Value Assessment Within the Cost-Effectiveness Framework: An Introduction
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The document discusses innovative approaches to value assessment in healthcare, highlighting the limitations of traditional cost-utility analysis (CUA) and promoting alternative methods for evaluating healthcare interventions. A special task force aims to produce a policy white paper to enhance decision-making frameworks by incorporating a broader range of value elements, including patient-reported outcomes and equity considerations. Recommendations call for healthcare coverage decisions to be based on comprehensive evaluations of costs and benefits, moving beyond conventional methodologies.
Novel Approaches to Value Assessment Within the Cost-Effectiveness Framework: An Introduction
- 1. Novel Approaches to Value Assessment Within the Cost-Effectiveness Framework: An Introduction ISPOR Value Summit Washington, D.C, Oct. 19, 2018 Lou Garrison, PhD The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute School of Pharmacy, Univ. of Washington Seattle WA 98195 1
- 2. Panelists • Lou Garrison, Ph.D., University of Washington, Seattle, WA, USA “An introduction” • Jeroen Jansen, PhD, Innovation and Value Initiative, Los Angeles, CA, USA “Moving beyond conventional cost-effectiveness analysis?” • Nancy Devlin, PhD, Office of Health Economics, London, UK “Extending the scope of patient-reported outcomes and QALYs” • Susan Griffin, PhD., University of York, York, UK “Distributional cost-effectiveness analysis (CEA)” DISCUSSION 2
- 3. Overall Objective of the Special Task Force The Special Task Force (STF) will produce a scientific policy white paper that reviews relevant perspectives and appropriate approaches and methods to support the construction and use of high-quality health care value frameworks that will enable more efficient health sector decision-making in the US. 3
- 4. ISPOR Initiative on U.S. Value Assessment Frameworks Source: STF Final Report, Section 1 (Neumann et al, Value Health, Feb. 2018)
- 5. Yes, 4 Yes, but…, 11 No, 3 N=18 83% responded “yes” but most noted qualifications: 1. CUA contains limitations or is incomplete (n=5) 2. CUA is one of many possible approaches (n=3) 3. The approach must utilize appropriate measures (n=3) Expert Advisory Board survey question: Do you believe that cost- utility analysis is a valid approach for measuring the value of healthcare interventions? Key suggested alternatives to CUA included: • Expanded/extended/enhanced/modified CUA analysis (n=4) • Value assessment focused on willingness to pay (WTP) (n=2) • Alternatives to CUA (e.g. multi-criteria decision analysis) (n=2)
- 6. ISPOR Special Task Force on US Value Assessment Frameworks Leadership Group Lou Garrison, PhD (co-chair) University of Washington, Seattle, WA, USA Peter J. Neumann, ScD (co-chair) Tufts University School of Medicine, Boston, MA, USA Richard J. Willke, PhD (CSO) ISPOR, Lawrenceville, NJ, USA Members Anirban Basu, PhD, University of Washington, Seattle, WA, USA Patricia M. Danzon, PhD The Wharton School, University of Pennsylvania, Philadelphia PA, USA Jalpa Doshi, PhD University of Pennsylvania, Philadelphia PA, USA Michael Drummond, MCom, DPhil University of York, York, UK Darius Lakdawalla, PhD, University of Southern California, Los Angeles, CA, USA Mark V. Pauly, PhD, The Wharton School, University of Pennsylvania, Philadelphia PA, USA Charles E. Phelps, PhD, University of Rochester, Gualala, CA, USA Scott D. Ramsey, MD, PhD University of Washington, Seattle, WA, USA Adrian Towse, MA, MPhil Office of Health Economics, London, UK Milton C. Weinstein, PhD Harvard University, Cambridge, MA, USA
- 7. ISPOR Initiative on US Value Assessment Frameworks STF Final Report. Feb. 2018
- 8. What is “Value”? • From an economic perspective: – Value is what someone is (actually) willing to pay or forgo to obtain something (opportunity cost) • Implications: – Varies across individuals, across indications for the same medicine, and dynamically over time (as more evidence becomes available and competitors emerge). – Difficult to measure in health care because of insurance – In principle, we would ask a plan member about their willingness to pay the incremental insurance premium (or taxes). In practice, the amount is too small to be estimated reliably. 8
- 9. Recommendations of the ISPOR Special Task Force on U.S. Value Assessment Frameworks Final Report February 2018
- 10. Recommendation II: Base health plan coverage and reimbursement decisions on an evaluation of the incremental costs and benefits of healthcare technologies as is provided by cost-effectiveness analysis. 1. Cost-per-QALY analyses have strengths and limitations 2. Frameworks that focus on coverage/reimbursement should consider cost per QALY, as a starting point 3. Consider elements not normally included in CEAs (e.g., severity of illness, equity, risk protection) but more research needed. Source: STF Final Report Section 7 (Garrison, Neumann, et al, Value Health, Feb. 2018)
- 11. STF Report Section 3: The Case for Augmented Cost- Effectiveness Analysis and Net Monetary Benefit
- 12. Value Quality- adjusted life-years (QALYs) gained Net costs Productivity Adherence- improving factors Reduction in uncertainty Fear of contagion Insurance value Severity of disease Value of hope Real option- value Equity Scientific spillovers Green circles: core elements of value Light blue circles: common but inconsistently used elements of value Dark blue circles: potential novel elements of value Blue line: value element in traditional payer perspective Red line: value element also included in societal perspective. Potential Elements of Value for Augmented Cost- Effectiveness Analysis (ACEA)
- 13. Thanks for your attention! lgarrisn@uw.edu
Editor's Notes
- #6: Note on physicians: 2-3 respondents did not thing this perspective SHOULD be accounted for in CUA. Could break up yes into two shades and include qualifications