The Value of Medicines: A Crucial but Vague Concept

Abstract

Health Technology Assessment is increasingly used to evaluate the value of healthcare products and to prioritize resources; however, defining exactly what value is and how it should be measured remains a challenge. In this article, we report the results of a literature review, focusing on nine European countries, with the aim of investigating how value is defined from the perspective of different stakeholders, how definitions of value are used, and how value is incorporated into decision making. Only three articles were identified that presented definitions of value, and there was no single shared definition of value in healthcare, which appears to be a highly subjective concept. The majority of the countries investigated combine clinical assessment with economic evaluation to make reimbursement recommendations; the quality-adjusted life-year is the most commonly used measure of value but does not capture broader aspects of value that may be important to patients and healthcare systems. We describe the use of value-based pricing and multi-criteria decision analysis, two approaches to the incorporation of broader aspects of value into decision making. Overall, we have identified considerable variation in how a product's value is defined by different stakeholders. Although a universal understanding of value in healthcare is important, it is clear that current definitions are insufficient, potentially leading to inconsistent reimbursement decisions. Ultimately, the establishment of clearer policies for defining and measuring value in healthcare is needed, and is likely to lead to improvements in the consistency of decision making.

A Review of Patient-Reported Outcome Data for Palliative Cancer Drugs Approved In the European Union

“…In EU calls for policy changes in HTA models are rising. Recent EU, WHO and others findings highlight inconsistency, variability and lack of predictability in the current HTA value frameworks urging authorities to encompass all attributes recommended by the EUnetHTA Core Model® where patient perspective, including PRO, should be considered [10][11][12][13][14][15][16][17][18][19].…”

Role of Health Technology Assessment in Pharmaceutical Market Access in Developed Countries

“…Consequently, these new medicines should command lower or similar prices to existing standards; or at best only limited increases versus existing standards based on HTA as well as key pricing and reimbursement considerations [4,5,21,41,72]. However, currently concerns with the definition of innovation and value, as well as issues of priority, unmet need and emotion, cloud such discussions and deliberations [63,[73][74][75][76]. This is a challenge for the future especially in Europe to maintain the ideals of equitable and comprehensive healthcare.…”

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