Workshop Looks “Under the Hood” of Value Assessment Frameworks

During the Feb. 27 interactive workshop, “Understanding the Strengths and Limitations of Value Assessment Frameworks,” hosted by the National Pharmaceutical Council and PhRMA, health care stakeholders "took a look under the hood" of three value assessment frameworks to gain a better understanding of how assessments work and where there is room for improvement.

Value assessment frameworks are being developed in response to the needs of patients, clinicians and payers to systematically evaluate or compare therapies. Current, prominent frameworks such as the ones from Memorial Sloan Kettering Cancer Center (DrugAbacus), the American Society of Clinical Oncology (ASCO) and the Institute for Clinical and Economic Review (ICER) each use different inputs and algorithms in their evaluations. These frameworks also are geared toward different audiences, with ASCO focused on patients and physicians and ICER on payers.

“If you do the calculations, then you'll really understand what's going on under the hood,” said Joshua Cohen, PhD, of the Center for Evaluation of Value and Risk in Health at Tufts Medical Center, who led the hands-on exercise segments of the workshop. “By seeing the implications of those calculations, that will give you a lot of information about those frameworks. Do we get answers that are consistent with our intuition? If not, then we need to think about how to improve those frameworks.”

Dr. Cohen and his colleagues, Peter Neumann, ScD, and Jordan Anderson, BA, led participants through three case studies that were detailed in their recent peer-reviewed paper, “Three Sets of Case Studies Suggest Logic and Consistency Challenges With Value Frameworks.” Neumann emphasized that while “it’s easier to criticize someone else than to come up with your own framework,” it is important to explore whether these frameworks align with logical and credible characterizations of value. By working through the hands-on examples, Cohen, Neumann and Anderson helped participants understand the specific inputs in each framework, along with the assumptions that need to be made to complete an evaluation of a treatment.

A variance in inputs and algorithms among the frameworks is not a negative, however. Given the variety of viewpoints and needs of different end users, one framework cannot address the interests of every stakeholder. In research and work on frameworks, NPC has highlighted the need for these different viewpoints and encouraged framework developers to follow Guiding Practices for Patient-Centered Value Assessment to ensure that patients’ views and a broad range of factors are considered in their frameworks. Additionally, this week the Health Affairs Blog published NPC’s study outlining ways to move the field of value assessment forward.

To learn more about the discussion, read the Tufts team’s study in Value in Health, and view additional information about value assessment on NPC’s website, including our guiding practices, current landscape assessment and explainer video.