What is value assessment?
As the U.S. health care system shifts from one driven by the volume of health care services to one focused on the value of health care provided, value assessment is a way of measuring the value of a health care treatment or service.
Typically, value assessment involves the use of health economic models, methodological approaches and inputs to derive a numerical or categorical output or range of outputs.
Value assessment is an evolving field in the United States. There are many ways to evaluate the value of a health care treatment; a “one-size-fits-all” approach will not meet the needs of all stakeholders.
Payers are looking for ways to measure value, but patients seek to access to treatments that will improve their lives. As interest grows in measuring value in health care, stakeholders must assess how to take a holistic approach that ensures outcomes patients value are incorporated.
Conversely, narrow approaches to value assessment, such as those that exclusively focus on biopharmaceuticals, cause us to lose sight not only of how all aspects of the system work together, but of how we can ensure that patients’ views and needs are recognized,
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.
Development of Value Assessment Frameworks
Focusing on value can enable efficient use of resources, incentivizing use of high-value services and treatments and discouraging the use of low-value services. Some stakeholders have developed value frameworks as a way to measure value.
As value assessment becomes more ingrained in health care decision-making, it’s important to be aware of how frameworks differ in their respective strengths and limitations.
Value assessments are a new and evolving area in the United States, 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), National Comprehensive Cancer Network (NCCN) and the American Society for Clinical Oncology (ASCO), have developed frameworks to assess new treatments.
Incorporating Patient Perspectives
While we recognize the importance of evaluating treatment value, 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, and incorporating 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.