Value Assessment Frameworks
There are many aspects to the U.S. health care system, as well as many different stakeholder viewpoints on how to address current challenges as our system shifts from one driven by the volume of health care services to one focused on the value of health care that is provided. As part of this shift and as a way to address health care costs, there is an increased interest in understanding how to assess the value of all aspects of health care.
Value assessments are a new and evolving area, and they have the potential to have a tremendous impact on patient treatment decisions, as well as on coverage and reimbursement decisions. In recent years, a number of organizations, such as the Institute for Clinical and Economic Review (ICER), Sloan Kettering Memorial Cancer Center (Drug Abacus) and the American Society for Clinical Oncologists (ASCO) have developed frameworks to assess new treatments.
While we recognize the importance of evaluating treatment costs, many of these frameworks fall short in their efforts to balance this evaluation with a comprehensive consideration of benefits to the patient. By not incorporating the full value and benefits of medical innovation, as well as the patient's input, frameworks will fall short of their goal to meaningfully assess value.
To keep patient concerns front and center, it’s important to assess the issue of value through a broader, patient-focused lens. Given the National Pharmaceutical Council’s role as a policy research organization with a commitment to ensuring the use of sound methodology, we developed “guiding practices for patient-centered value assessment” to help stakeholders comprehensively consider value with the patient in mind.
- NPC's "Guiding Practices for Patient-Centered Value Assessment" establish good practices to guide meaningful value assessments. The Guiding Practices address the assessment process; methodology; benefits; costs; evidence; and dissemination and utilization, as well as considerations for budget impact assessment.
- NPC's "Current Landscape: Value Assessment Frameworks" builds on Neumann and Cohen's informative comparison of frameworks by carrying the assessment further and providing specific detailed observations. It delves deeper into the rather disparate frameworks by comparing and contrasting key characteristics such as their intended purposes, development processes, methods, and the elements of value (benefits and costs).
- NPC also has outlined concerns with the Institute for Clinical and Economic Review's (ICER) Value Assessment Framework in both comments and a letter to ICER President Dr. Steven Pearson. NPC cited the framework’s lack of model transparency, challenges with how the health system value is calculated, and the need to realize the effects of some treatments over a longer time horizon, among other concerns.
- NPC submitted comments to the American Society of Clinical Oncology on the proposed “Framework to Assess the Value of Cancer Treatment Options,” intended to help patients and providers assess the relative value of cancer therapies. NPC’s comments focused on how to improve the patient-centricity of the framework to enhance its ultimate value as a shared decision-making tool. In particular, NPC recommended broadening the framework to include more factors that patients value, strengthening the assessments of clinical benefits and toxicity, ensuring cost information is relevant to patients, expanding the evidence base that underlies the framework, and safeguarding against framework misuse.