By convention, values for generic ‘preference-based’ measures, such as the EQ-5D, are anchored at 1 = full health and 0 = dead. This paper challenges the assumption that anchoring health state values at ‘dead = 0’ is a necessary condition for values to be used in quality-adjusted life year (QALY) estimation. The authors consider five propositions, using narrative review of the literature and conceptual explication of the problem:
Determining and defining value in health care is a persistent challenge in every country. To some extent, what constitutes value depends on perspective, e.g. a pharmaceutical company may view value somewhat differently than a doctor or a hospital administrator.
Errea, M., Skedgel, C., Zamora, B., G, Hampson., R, Althin., Hofmarcher, T., Lindgren, P., & Cookson, G.
Substantial economic resources are devoted to healthcare across Europe, but there is evidence that a large proportion of these resources are of limited benefit to patients and society. Around 10% of European Gross Domestic Product (GDP) is spent on healthcare and estimates suggest that as much as one-fifth of this amount (2% of GDP) is spent on interventions that make no meaningful contribution to health outcomes. In economic terms, these resources are used inefficiently.
Pearson, S., Lowe, M., Towse, A., K., Segel, C. and Henshall, C.
In the focus on US drug prices, ICER has contributed thinking on determining when price aligns with patient benefits. Less debated is whether insurance coverage provides patients with fair access to a drug with a fair, value-based, price. But how do we define fair access? This paper from ICER and OHE authors develops a fair access framework, proposing Ethical Goals for Access and Fair Design Criteria for cost sharing and prior authorization protocols.
OHE is undertaking a research programme called the Broad Assessment of Value in Vaccines Engagement (BRAVE). The overarching aim of the BRAVE initiative is to increase recognition of the broader value elements of vaccines and consistency of their assessment within HTA and wider decision-making processes in various countries, including Belgium, Canada, France, Germany, Italy, Japan, Sweden, the UK and the US.
Histology independent therapies, a new class of medicines that target cancer based on specific genomic or molecular alterations of cancer cells rather than tissue of origin, face significant methodological and policy hurdles related to evidence development and acceptance, value assessment and reimbursement pathways, and diagnostic infrastructure availability.
The issue of rising prescription drug prices is a concern in every country. Dozens of policy initiatives and hundreds of research projects over last the fifty years have attempted to find solutions to pricing that provide an appropriate balance between the cost to health care systems and incentives for R&D. To name but a few, these include reference pricing, managed entry agreements, price-volume agreements, rebates, and risk sharing. The ultimate solution, however, remains elusive.
Most value assessments of vaccination programs are carried out by taking the perspective of the health system. To stimulate the debate concerning the broader value of vaccination beyond this perspective, this report quantifies the related return on investment to the UK government.
Brassel, S., Neri, M., O’Neill, P. and Steuten, L.
Many health technology assessment (HTA) agencies limit their assessment of vaccines to individual health benefits and the costs associated with vaccine administration and the disease avoided. However, compared to other health technologies, the standard evaluation approaches have often been criticised as inadequate to accurately estimate the value of vaccines.
This year’s OHE lecture addresses the question: how should the world pay for a COVID-19 vaccine? Adrian Towse, Emeritus Director of OHE and Senior Research Fellow presents the challenges that we face in developing a COVID-19 vaccine,and suggests a mechanism for buying the vaccine on a global scale. This paper was published alongside the lecture but contains additional analysis, extensive footnotes and references. Comments and feedback are welcome.