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Developing a Value Framework: The Need to Reflect the Opportunity Costs of Funding Decisions

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Publication details

JournalValue in Health
DateE-pub ahead of print - 24 Feb 2017
DatePublished (current) - Feb 2017
Issue number2
Number of pages6
Pages (from-to)234-239
Early online date24/02/17
Original languageEnglish


A growing number of health care systems internationally use formal economic evaluation methods to support health care funding decisions. Recently, a range of organizations have been advocating forms of analysis that have been termed "value frameworks." There has also been a push for analytical methods to reflect a fuller range of benefits of interventions through multicriteria decision analysis. A key principle that is invariably neglected in current and proposed frameworks is the need to reflect evidence on the opportunity costs that health systems face when making funding decisions. The mechanisms by which opportunity costs are realized vary depending on the system's financial arrangements, but they always mean that a decision to fund a specific intervention for a particular patient group has the potential to impose costs on others in terms of forgone benefits. These opportunity costs are rarely explicitly reflected in analysis to support decisions, but recent developments to quantify benefits forgone make more appropriate analyses feasible. Opportunity costs also need to be reflected in decisions if a broader range of attributes of benefit is considered, and opportunity costs are a key consideration in determining the appropriate level of total expenditure in a system. The principles by which opportunity costs can be reflected in analysis are illustrated in this article by using the example of the proposed methods for value-based pricing in the United Kingdom.

Bibliographical note

© 2017, International Society for Pharmacoeconomics and
Outcomes Research (ISPOR). This is an author-produced version of the published paper. Uploaded in accordance with the publisher’s self-archiving policy.

    Research areas

  • value frameworks, opportunity costs, QALYS, value-based pricing

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