Defining Elements of Value in Health Care—A Health Economics Approach: An ISPOR Special Task Force Report [3]

Abstract

The third section of our Special Task Force report identifies and defines a series of elements that warrant consideration in value assessments of medical technologies. We aim to broaden the view of what constitutes value in health care and to spur new research on incorporating additional elements of value into cost-effectiveness analysis (CEA). Twelve potential elements of value are considered. Four of them-quality-adjusted life-years, net costs, productivity, and adherence-improving factors-are conventionally included or considered in value assessments. Eight others, which would be more novel in economic assessments, are defined and discussed: reduction in uncertainty, fear of contagion, insurance value, severity of disease, value of hope, real option value, equity, and scientific spillovers. Most of these are theoretically well understood and available for inclusion in value assessments. The two exceptions are equity and scientific spillover effects, which require more theoretical development and consensus. A number of regulatory authorities around the globe have shown interest in some of these novel elements. Augmenting CEA to consider these additional elements would result in a more comprehensive CEA in line with the "impact inventory" of the Second Panel on Cost-Effectiveness in Health and Medicine. Possible approaches for valuation and inclusion of these elements include integrating them as part of a net monetary benefit calculation, including elements as attributes in health state descriptions, or using them as criteria in a multicriteria decision analysis. Further research is needed on how best to measure and include them in decision making.

Should health technology assessment be more patient centric? If so, how?

“…Many of these elements of value, such as impacts on work participation, increased convenience in receiving care, insurance value, the value of hope and impacts on caregivers, would be of direct interest to patients [14]. Other authors argue that value "lies in the eye of the patient" [15], suggesting that patient-reported outcome measures (PROMs) are an invaluable source of data that can and should be used to inform HTA.…”

Approaches to Aggregation and Decision Making—A Health Economics Approach: An ISPOR Special Task Force Report [5]

“…There remain a number of these other elements, some discussed in the article by Lakdawalla et al [4], that analysts in concept could include in a CEA (or CBA) structure, but cannot meaningfully do so because relevant data do not exist, and are impractical for real-world analysts at present. Consider, as an example, a vaccine against or the treatment of a virulent disease such as Zika and Ebola or historical predecessors such as leprosy, tuberculosis, poliomyelitis, severe acute respiratory syndrome, and AIDS.…”

“…This includes, for example, things such as fit with existing infrastructure/programs; availability of requisite trained personnel; improvement in children's school participation and highest grade attainment (and hence future earnings); ethical considerations (e.g., involving end-of-life alternatives or manipulation of genetic material); and-for an individual patient-fears associated with specific types of therapies (e.g., radiation and genetic modification). It also includes other elements discussed in the article by Lakdawalla et al [4]. In what follows, we discuss methods that could be used to include both these less tractable and the more traditional value elements in a consolidated valuation.…”

“…Financial risk protection reflects the reduction in the risk of financial distress due to health care costs, or the financial costs of poor health. It represents a subset of the "insurance value" concept discussed in the article by Lakdawalla et al [4]. Cost is measured from the perspective of the society as a whole, as is common in CEA.…”

Practical Next Steps in Improving Value Measurement and Use

“…To address this issue, a list of potential elements for next-generation value assessment was developed by the International Society for Pharmacoeconomics and Outcomes Research. 4 Dr M. B. McClellan provided additional context for these novel value elements by providing specific examples for each. 5 I do not believe we should focus on any specific value measure, because they all have merit for certain circumstances-our focus should be on addressing the larger issue of the insensitivity of utility methods used in QALY assessments.…”