By: Laura Prieto
MD, Msc
NeuroeconomixBy: Camilo Castañeda
MD, Esp
Neuroeconomix
The main recommendation to establish a value framework is to exalt the QALY as one of the pillars to identify if a health plan should cover or reimburse a specific technology, considering other elements as well.
The international society of pharmacoeconomics and in outcomes research (ISPOR) is the world’s leading organization for the study and expansion of the health economy. The Special Task Force (STF) published a scientific document this year where, from a health economics perspective, it seeks to establish a conceptual framework and gives six recommendations to establish therapeutic value.
Likewise, it is proposed that due to the different needs of health systems and their actors, especially patients, the QALY is not able to comprehensively encompass or represent non-traditional aspects such as equity, severity of the disease and hope in the framework of an economic study or a cost-effectiveness evaluation. Therefore, these studies could be supported by methodologies such as multicriteria decision analysis (MCDA).
The therapeutic value is due to the fact that it is increasingly important to incorporate into the measure of value what patients report or perceive about the health benefits of an intervention and thus increase its legitimacy.
There are many potential areas for improvement in the way that value frameworks evaluate benefits, costs and other factors relevant to decision making. Here are 6 key recommendations from the STF 2018, A Health Economics Approach to US Value Assessment Frameworks:
1. Be explicit about the decision context and the perspective in which you want to establish value assessment frameworks
2. Decisions to establish a benefit plan and reimbursement policies should be made within the framework of a cost-effectiveness analysis that reflects an evaluation of the incremental costs and benefits of the technologies in question
3. Value thresholds should be developed that serve as important input to help guide hedging policies and reimbursement decisions. The use of cost ranges by QALY, with consideration of other elements, can help achieve maximum health benefit with available resources
4. Manage budget constraints and «ability to pay» based on the principles of cost-effectiveness
5. Test and consider, structured deliberation processes, when devising health benefit plans and reimbursement decisions
6. Explore and incorporate new elements to improve value measures that reflect the perspectives of decision makers and patients
Concerning about the rising cost of health care in the United States and other countries around the world, decision makers are developing new value assessment frameworks that attempt to quantify which treatments provide the greatest benefits, for patients and for the sustainability of health systems.
For more information, go to the ISPOR main page and the next document issued by the association, with updated recommendations for value frames.
- Garrison LP Jr, Neumann PJ, Willke RJ, Basu A, Danzon PM, Doshi JA, Drummond MF, Lakdawalla DN, Pauly MV, Phelps CE, Ramsey SD, Towse A, Weinstein MC. A Health Economics Approach to US Value Assessment Frameworks-Summary and Recommendations of the ISPOR Special Task Force Report . Value Health. 2018 Feb; 21 (2): 161-165. doi: 10.1016 / j.jval.2017.12.009. PubMed PMID: 29477394.
