Defining Value

As part of the U.S. health care system's increasing focus on the value of care rather than the volume of care provided, as well as concerns over health care costs, there is an increased interest in understanding how to assess the value of all aspects of health care.

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. In recent years, a number of organizations, such as the Institute for Clinical and Economic Review (ICER), Sloan Kettering Memorial Cancer Center (Drug Abacus) and the American Society for Clinical Oncology (ASCO) have developed frameworks to assess new treatments.

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. Given the National Pharmaceutical Council’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.

These guiding practices outline six key areas for defining value:

  • Assessment process: Stakeholder input and feedback should be incorporated throughout the assessment process, from the announcement of topics to be examined through the entire review cycle. In addition, assessments should be regularly reviewed to keep pace with continued medical innovation.
  • Methodology: Assessments should focus on all aspects of the health care system, use established methods and transparent models and assumptions, and include guidance to help users understand key drivers behind the results.
  • Benefits: Assessments should include a broad array of factors that matter to patients and society, consider individual treatment effects and view the value of a treatment over a long-term horizon.
  • Costs: All health care costs and offsets over time should be considered, and these costs should be accurate and relevant to the user of the framework.
  • Evidence: All of the sound, high-quality evidence that is currently available should be utilized for the assessment. It should be gathered and synthesized in a transparent and robust manner, using accepted methods.
  • Dissemination and Utilization: Assessments should be clearly labeled for their intended use, easy for users to interpret, and disseminated only after they are finalized.