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How to establish therapeutic value? 6 contributions of pharmacoeconomics


By: Laura Prieto
MD, Msc 

By: Camilo Castañeda
MD, Esp

The main recommendation to establish a value framework is to exalt QALY as one of the pillars to identify if a health plan should cover or reimburse a specific technology, also considering other elements.

The International Society for Pharmacoeconomics and Outcomes Research (ISPOR) is the world champion organization for the study and expansion of health economics. Your special task team or Special Task Force (STF) published this year a scientific document where, from a health economics perspective, it seeks to establish a conceptual framework and gives six recommendations for 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 encompass or comprehensively represent aspects non-traditional What fairness, severity of illness and hope within the framework of an economic study or a cost-effectiveness evaluation. Therefore, these studies could be supported by methodologies such as multi-criteria decision analysis.

This is due to the fact that it is becoming more and more relevant 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 value frameworks assess benefits, costs and other relevant factors for decision making.


Here are 6 key recommendations of the STF of Ispor 2018, A Health Economics Approach to US Value Assessment Frameworks:

Be explicit about the decision context and the perspective in which you want to establish the value assessment frameworks

Decisions to establish a benefit plan and refund policies should be taken within the framework of a cost-effectiveness analysis that reflects a assessment of incremental costs and benefits of the technologies in question.

Should be develop value thresholds that serve as input important to help guide coverage policies and reimbursement decisions. The use of cost ranges per QALY, with consideration of other elements, can help achieve maximum health benefit with available resources.

Manage the budget constraints and "ability to pay" based on the principles of cost-effectiveness.

Try and consider, structured deliberation processes, when devising health benefit plans and reimbursement decisions

Explore and incorporate new elements, to improve measures of value that reflect the perspectives of decision makers and patients.


Amid concerns about the rising cost of healthcare 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, both for patients and for the sustainability of health systems.

For more information, go to the ISPOR home page and to the following document issued by the association, with the updated recommendations for value frameworks.


PDF document


  1. 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 [7]. Value Health. 2018 Feb; 21 (2): 161-165. doi: 10.1016 / j.jval.2017.12.009. PubMed PMID: 29477394.
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