Analysis: More progress needed before widespread adoption of healthcare value assessments

Reviewed by James Ives, M.Psych. (Editor)Sep 23 2019

Value in Health, the official journal of ISPOR- the professional society for health economics and outcomes research, announced today the publication of an analysis showing that while value assessment frameworks are moving closer to meeting the challenge of accurately measuring value and reliably informing healthcare decisions, more progress is needed before widespread adoption and use. The study, "As Value Assessment Frameworks Evolve, Are They Finally Ready for Primetime?," was published in the September 2019 issue of Value in Health. An accompanying commentary by Peter J. Neumann, ScD, Center for the Evaluation of Value and Risk in Health at the Institute for Clinical Research and Health Policy Studies at Tufts Medical Center, Boston, MA, USA, appears in the same issue of Value in Health.

Authors Dubois and Westrich briefly describe the evolution of the value assessment framework landscape in the United States, including new entrants and updated frameworks. To assess whether this evolution successfully advances the field of value assessment, they examined the current frameworks actively conducting assessments-;those from the Institute for Clinical and Economic Review, Innovation and Value Initiative, and National Comprehensive Cancer Network-;relative to 6 key considerations for improvement. These 6 considerations were identified via a prior peer-reviewed analysis based on the National Pharmaceutical Council's Guiding Practices for Patient-Centered Value Assessment. They include:

1. Value assessments should be transparent and reproducible
2. Value is dynamic and needs to be considered and captured as such
3. Value assessments should adopt broad system perspectives in what they assess and how they assess it
4. Value assessments should incorporate what is important to patients, even if the end user for a framework is the payer
5. A diversity of value assessment approaches that reflect the differing needs of stakeholders should remain; value assessments should reflect user preferences
6. Assessments of value should be separate from assessments of budget impact and affordability

The analysis found that value assessment frameworks are moving closer to meeting the challenge of accurately measuring value and reliably informing healthcare decisions, but more progress is needed before widespread adoption and use.

Our investigation shows that the field of value assessment has advanced in most areas. Indeed, each of the 6 considerations has been addressed in some way by at least one framework. However, more progress is needed before the widespread adoption of frameworks for decision making. Users must be aware that these assessments have limitations, and wholesale adoption is not wise. While value assessments are potential inputs that can be considered for healthcare decision making, none of them should be the sole input for these decisions. Considering the limitations, they should, at most, be only one of many tools in the toolbox."

Kimberly Westrich, MA, Vice President of Health Services Research, The National Pharmaceutical Council, Washington, DC, USA