A Health Economics Approach to US Value Assessment Frameworks - Summary and Recommendations of the ISPOR Special Task Force Report [7]

TY - JOUR

T1 - A Health Economics Approach to US Value Assessment Frameworks - Summary and Recommendations of the ISPOR Special Task Force Report [7]

AU - Garrison, Louis R.

AU - Neumann, P.

AU - Willke, R.

AU - Basu, A.

AU - Danzon, P.

AU - Doshi, J.

AU - Drummond, M.F.

AU - Lakdawalla, D.

AU - Pauly, Markus

AU - Phelps, C.

AU - Ramsey, S.

AU - Towse, A.

AU - Weinstein, M.

N1 - © 2018, International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. This is an author-produced version of the published paper. Uploaded in accordance with the publisher’s self-archiving policy.

PY - 2018/2/23

Y1 - 2018/2/23

N2 - This summary section first lists key points from each of the six sections of the report, followed by six key recommendations. The Special Task Force chose to take a health economics approach to the question of whether a health plan should cover and reimburse a specific technology, beginning with the view that the conventional cost-per-quality-adjusted life-year metric has both strengths as a starting point and recognized limitations. This report calls for the development of a more comprehensive economic evaluation that could include novel elements of value (e.g., insurance value and equity) as part of either an “augmented” costeffectiveness analysis or a multicriteria decision analysis. Given an aggregation of elements to a measure of value, consistent use of a costeffectiveness threshold can help ensure the maximization of health gain and well-being for a given budget. These decisions can benefit from the use of deliberative processes. The six recommendations are to: 1) be explicit about decision context and perspective in value assessment frameworks; 2) base health plan coverage and reimbursement decisions on an evaluation of the incremental costs and benefits of health care technologies as is provided by cost-effectiveness analysis; 3) develop value thresholds to serve as one important input to help guide coverage and reimbursement decisions; 4) manage budget constraints and affordability on the basis of cost-effectiveness principles; 5) test and consider using structured deliberative processes for health plan coverage and reimbursement decisions; and 6) explore and test novel elements of benefit to improve value measures that reflect the perspectives of both plan members and patients.

AB - This summary section first lists key points from each of the six sections of the report, followed by six key recommendations. The Special Task Force chose to take a health economics approach to the question of whether a health plan should cover and reimburse a specific technology, beginning with the view that the conventional cost-per-quality-adjusted life-year metric has both strengths as a starting point and recognized limitations. This report calls for the development of a more comprehensive economic evaluation that could include novel elements of value (e.g., insurance value and equity) as part of either an “augmented” costeffectiveness analysis or a multicriteria decision analysis. Given an aggregation of elements to a measure of value, consistent use of a costeffectiveness threshold can help ensure the maximization of health gain and well-being for a given budget. These decisions can benefit from the use of deliberative processes. The six recommendations are to: 1) be explicit about decision context and perspective in value assessment frameworks; 2) base health plan coverage and reimbursement decisions on an evaluation of the incremental costs and benefits of health care technologies as is provided by cost-effectiveness analysis; 3) develop value thresholds to serve as one important input to help guide coverage and reimbursement decisions; 4) manage budget constraints and affordability on the basis of cost-effectiveness principles; 5) test and consider using structured deliberative processes for health plan coverage and reimbursement decisions; and 6) explore and test novel elements of benefit to improve value measures that reflect the perspectives of both plan members and patients.

KW - augmented cost-effectiveness analysis

KW - benefit-cost analysis

KW - multi-criteria decision analysis

KW - value frameworks

U2 - 10.1016/j.jval.2017.12.009

DO - 10.1016/j.jval.2017.12.009

M3 - Article

SN - 1098-3015

VL - 21

SP - 161

EP - 165

JO - Value in Health

JF - Value in Health

IS - 2

ER -