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Developing and Using Value Frameworks

With the increase in the use of innovative specialty biopharmaceuticals and targeted therapies to treat broader populations, we’re seeing more people who are being cured, managing their chronic conditions or living healthier lives. But this better health often comes with a price tag, which is why various organizations in the United States have begun developing their own value assessment frameworks.

What are these frameworks, and which organizations are behind them? Briefly, these include:

  • The American College of Cardiology/American Heart Association, known for their development of evidence-based clinical practice guidelines, recently added a value component to their guidelines.  
  • Premera Blue Cross developed a “value-based formulary” for employers with tiers based on incremental cost effectiveness ratios.
  • DrugAbacus was created by Memorial Sloan Kettering Cancer Center as an online tool to calculate a preference-weighted value-based price.
  • The Institute for Clinical and Economic Review’s Value Assessment Framework is designed for insurers making coverage policy decisions.
  • The National Comprehensive Cancer NetworkÒ Evidence Blocks are intended to provide information to support shared decision-making between physicians and patients.
  • The American Society of Clinical Oncology Value Framework is intended for physicians and patients to use when making treatment decisions. It does not incorporate cost-effectiveness thresholds, but uses measures of both clinical benefit and treatment cost.

This proliferation in frameworks raises concerns. For example:

  • Many of the frameworks lack transparency, which creates uncertainty about the trustworthiness of the methods and the output.
  • Many of the methodologies and thresholds used in the frameworks have not been tested or vetted which not only causes uncertainty about the validity of the results; it also creates uncertainty around whether the assessments are useful for their intended purpose.
  • The evidence base for many of the frameworks is quite limited, which can have a tremendous impact on the results.

Is there a way to guide the creation of a better framework? Perhaps. A good framework should start with good principles of value assessment. NPC is developing principles for broader consideration among health care stakeholders. Here are just a few ideas for consideration:

  • Examine all aspects of care, not just drugs;
  • Include all relevant stakeholders;
  • Time frames should encompass full benefits and harms;
  • Economic models should be readily available;
  • Transparency is needed at every step; and
  • Include customizable “weights” for key factors.

These ideas are simply a starting point for a broader conversation about value assessment principles and whether we can find some common ground to guide value assessment. It’s clear that value assessment frameworks are becoming more prevalent; whether they become useful tools to improve health care or blunt instruments to block access remains to be seen. Together, we can set a better path forward.

Interested in learning more about value assessment frameworks? Read NPC’s comments to ICER and ASCO, listen to Dr. Dubois’ webinar with ICER and the Academy of Managed Care Pharmacy, and read his upcoming column on this topic in the Journal of Comparative Effectiveness Research.