Rethinking Our Approach to Value Assessment to Ensure the Patient Voice is Heard

Value assessment frameworks are gaining traction in the United States. Increasingly, these frameworks have real-world applications and the potential to have lasting impacts on payers’ coverage decisions – and the lives of patients – despite important limitations. According to a panel at the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Summit 2018 and summarized this week in Value in Health, even though frameworks are growing in use, these value assessment tools are not ready for “prime time” as they leave out critical considerations, including the patient voice. 

National Pharmaceutical Council (NPC) Chief Science Officer and Executive Vice President, Robert Dubois, MD, PhD, participated in a summit moderated by Shelby D. Reed, RPh, PhD, alongside panelists F. Reed Johnson, PhD, Professor in Population Health Sciences at Duke University, J. Jaime Caro, MDCM, Chief Scientist, Evidera, and Charles E. Phelps, PhD, University Professor and Provost Emeritus, University of Rochester, to address considerations for how certain broader approaches to value assessment could be used when evaluating technologies. 

Their findings and conversation, published in Value in Health, suggest that value assessment frameworks need to address the following considerations to ensure patients are able to access the life-saving medications needed most:

• Most important, value assessments need to account for those most affected by all health and non-health consequences of a coverage decision: primarily the patient, but depending on the context, it also may include the plan population, caregivers, or others. 
• Second, there are lessons to be learned from quality frameworks from groups outside of the health care economics space that can assist in understanding nonmarket valuation methods as a guide for deliberative decision making. 
• Third, all approaches to value measurement must have high-quality, reliable data and continuous assessment of the methods used to obtain those data to ensure these tools are usable now and in the future. More research and testing is needed to understand the strengths and weaknesses of new approaches. 

The article also outlines NPC’s Guiding Practices for Patient-centered Value Assessment. For several years, NPC has been monitoring value assessment frameworks and engaging with developers on ways to improve their methodologies, involve patient organizations and use a broad range of evidence-based considerations. (Read more about NPC’s Guiding Practices and how we define and measure value.) 

Value assessments are becoming a broader part of the health spending conversation. By implementing these considerations and following guiding practices, we can work together to make health care value assessment and decision-making more transparent and responsive to underlying patient and societal values.