Rising health care costs and pharmaceutical prices in particular are among the main factors that have prompted a steady flow of scholarly and lay press articles about moving from paying for volume to paying for value. A variety of value assessment frameworks have been developed to compare the health and economic impacts of drugs and other interventions. In this article published on the Health Affairs Blog, NPC researchers Robert W. Dubois, MD, PhD, and Kimberly Westrich, MA, ask: Are these frameworks ready for the task? If not, what is needed?
To address this question, Dubois and Westrich applied the National Pharmaceutical Council’s Guiding Practices for Patient-Centered Value Assessment to frameworks developed by the American College of Cardiology/American Heart Association (ACC-AHA), American Society of Clinical Oncology (ASCO), Institute for Clinical and Economic Review (ICER), Memorial Sloan-Kettering Cancer Center (DrugAbacus), and National Comprehensive Cancer Network (NCCN). Based on that comparison and the resulting public discussion at a recent conference (Assessing Value: Promise and Pitfalls, Washington DC, 9/29/2016), they found that:
- each framework has strengths and limitations,
- all have clear opportunities for improvements, and
- none is fully matured and ready to support health care decision making.
Despite this lack of full maturity, some of these frameworks are operating, de facto, to influence health care decision making, and the demand that has fueled their development is unlikely to abate in an increasingly value-conscious environment. Since these frameworks are in flux and many of their limitations are broadly shared, Dubois and Westrich identified the following key considerations for improvement of value frameworks that might help to advance the field:
- Assessments of value should be separate from assessments of budget impact and affordability
- Value assessments should incorporate what is important to patients, even if the end user for a framework is the payer
- Value assessments should adopt broad system perspectives in what they assess and how they assess it
- Value is dynamic and needs to be considered and captured as such
- Value assessments should be transparent and reproducible
- A diversity of value assessment approaches that reflect the differing needs of stakeholders should remain; value assessments should reflect user preferences
- Insurance reform is needed along with improvements in value assessment frameworks so that patients can gain access to high value services (and low value services are discouraged)