By Ross Maclean, MD, Precision Value & Health

We must recognize that the term “value” may be more appropriately thought of as “benefit” which, in turn, triggers a discussion on the opportunity cost of other forgone benefits. New cost-effectiveness modeling methods are required to accommodate the novel sources of value.

MOVING BEYOND THE QALY

The recent ISPOR Special Task Force on U.S. Value Frameworks1 identified 12 value elements for healthcare innovation. With the quality-adjusted life year (QALY) as the starting point and adding accepted sources of value (such as cost savings, productivity, and the adherence-improving factor), Lakdawalla et al suggested several more novel, uncertainty-related sources, such as the value of hope, option value, and the value of knowing. Informally referred to as the “Value Flower,” this offers an interesting starting point to consider how novel sources of value may apply to European health technology assessment (HTA).

There appears to be broad support for a wider perspective on value. For example, an informal audience poll (N~300) at the start of the ISPOR-EU 2018 panel discussion, “Do Novel Value Measures Have a Place in European HTA?” (Breakout #2, IP6) revealed that around threequarters of respondents thought that the QALY inadequately captures the patient benefit and should be supplemented by other measures of value, and that the views of non-patients (also receiving benefits from the same payer) who may not receive the benefit of a new innovation — but will share the cost — should be included in HTA.

Read the full article in the September/October 2019 issue of Value & Outcomes Spotlight.