How Should Value in Health Care be Assessed?

Check out NPC's "Guiding Practices for Patient-Centered Value Assessment."

Value is a balance between BENEFITS & COSTS of treatments

In health care, the push to move from VOLUME TO VALUE has led health care stakeholders to try to quantify value through Value Frameworks including:

  • American College of Cardiology
  • American Heart Association.
  • ASCO
  • ICER. Institute for Clinical and Economical Review.
  • NCCN. National Comprehensive Cancer Network.
  • Memorial Sloan Kettering Cancer Center.

Who are value frameworks meant for? How are they being used?

  • HEALTH CARE PROFESSIONALS & PATIENTS To inform treatment decisions
  • PAYERS To inform coverage andreimbursement decisions

If value frameworks are meant to INFORM TREATMENT DECISIONS and GUIDE PAYMENTS, they need to be METHODOLOGICALLY SOUND, use CREDIBLE and TRANSPARENTassumptions, and meet the DIVERSE NEEDS of patients and providers.

Some Challenges in Current Value Frameworks

  • Use new untested methodologies.
  • Based on limited evidence,
  • Do not include all benefits that are important to patients.
  • Lack a health system-wide perspective.
  • Provide output that is unclear or confusing for users

Guiding Practices for Building Value Frameworks That Work for Patients

Done well, they have the power to promote value in PATIENT CARE

Done poorly, they could MISINFORM health care decisions and HARM
patient care and outcomes

To get them right, CURRENT and FUTURE frameworks should align to core practices:


  • Involve stakeholders throughout the entire process
  • Allow for public comment periods
  • Update assessments regularly to keep pace with


  • Include a broad array of factors that matter to patients
    and society
  • Consider individual treatment effects
  • View the benefits of a treatment over a long-term horizon


  • Use all of the sound, high-quality evidence that is
    currently available
  • Gather and synthesize evidence in a transparentand robust manner, using accepted practices


  • Focus assessments on all aspects of the health
    care system
  • Use established methods and transparent models
    and assumptions
  • Acknowledge uncertainty in input factors by
    reporting ranges around estimates


  • Consider all health care costs and offsets over time
  • Ensure costs are accurate and relevant to theuser of the framework


  • Label assessments clearly for their intended use
  • Make assessments easy for users to interpret
  • Disseminate publicly only after assessments are

But what about budget impact?

Budget impact assessments measure RESOURCE USE, not VALUE.
Guiding practices should:

  • Assess all aspects of care (such as hospitalization or doctors visits), not just medications
  • Keep budget impact and value assessments separate
  • Consider a longer time horizon that includes all costs and cost offsets
  • Acknowledge uncertainty in input factors by reporting ranges around estimates

Read NPC’s full Guiding Practices for Patient-Centered Value Assessment

1717 Pennsylvania Ave., NWSuite 800

Washington, DC 20006

National Pharmaceutical Council.

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<a href=''><img src='' alt='How Should Value in Health Care be Assesed' width='600px' border='0' /></a> <br><small>Source: <a href="">National Pharmaceutical Council</a></small></p>

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How Should Value in Health Care be Assesed? PDF