How can we measure the value of a health care treatment? How do we define value? Does this view change depending on the stakeholder?
To address these questions, as well as to address concerns about increasing health care costs, several organizations developed value assessment frameworks. These organizations include the Institute for Clinical and Economic Review (ICER), Sloan Kettering Memorial Cancer Center (Drug Abacus), the American Society for Clinical Oncology (ASCO), the American College of Cardiology-American Heart Association, and the National Comprehensive Cancer Network. Organizations such as the National Health Council have developed tools to assist patients as they evaluate and participate in assessments.
Value assessments are a new and evolving area, and they have the potential to have a tremendous impact on patient treatment decisions, as well as on coverage and reimbursement decisions.
While we recognize the importance of evaluating treatment costs, many of these frameworks fall short in their efforts to balance this evaluation with a comprehensive consideration of benefits to the patient. By not incorporating the full value and benefits of medical innovation, as well as the patient's input, frameworks will fall short of their goal to meaningfully assess value.
To keep patient concerns front and center, it’s important to assess the issue of value through a broader, patient-focused lens, an issue that was highlighted at the National Pharmaceutical Council's 2016 conference, Assessing Value: Promise and Pitfalls. Given NPC's role as a policy research organization with a commitment to ensuring the use of sound methodology, we developed “guiding practices for patient-centered value assessment” to help stakeholders comprehensively consider value with the patient in mind.
- NPC's "Guiding Practices for Patient-Centered Value Assessment" establish good practices to guide meaningful value assessments. The Guiding Practices address the assessment process; methodology; benefits; costs; evidence; and dissemination and utilization, as well as considerations for budget impact assessment.
- NPC's "Current Landscape: Value Assessment Frameworks" builds on Neumann and Cohen's informative comparison of frameworks by carrying the assessment further and providing specific detailed observations. It delves deeper into the rather disparate frameworks by comparing and contrasting key characteristics such as their intended purposes, development processes, methods, and the elements of value (benefits and costs).
- NPC also has outlined concerns with the Institute for Clinical and Economic Review's (ICER) Value Assessment Framework in both comments and a letter to ICER President Dr. Steven Pearson. NPC cited a need for:
- Full transparency and reproducibility of economic models
- Formal inclusion of patient-centered factors into the framework so they can be meaningfully considered in the value assessment
- A reevaluation of the appropriateness and approach to budget impact assessment and its relevance in calculating value-based price benchmarks
- Elimination of the “alarm bell” threshold, which does not involve a comprehensive consideration of the health care system, does not consider societal values, and does not adequately measure affordability
- NPC submitted comments to the American Society of Clinical Oncology on the proposed “Framework to Assess the Value of Cancer Treatment Options,” intended to help patients and providers assess the relative value of cancer therapies. NPC’s comments focused on how to improve the patient-centricity of the framework to enhance its ultimate value as a shared decision-making tool. In particular, NPC recommended broadening the framework to include more factors that patients value, strengthening the assessments of clinical benefits and toxicity, ensuring cost information is relevant to patients, expanding the evidence base that underlies the framework, and safeguarding against framework misuse.
In 2016, ASCO released an updated version of its framework, which now includes more factors that are of importance to patients, sharpens the methodology for measuring the benefits and toxicities of cancer treatments, and outlines plans to incorporate patient preference weighting in the software assessment tool under development. However, the framework still falls short in the areas of cost and evidence evaluation.