Cubi-Molla, P., Mott, D., Henderson, N., Zamora, B., Grobler, M. & Garau, M.
OHE explores the values of life that are used in analyses by the governmental departments of health, social care, environment, and transport, for a range of countries: Australia, Canada, Japan, New Zealand, South Korea, The Netherlands, and the UK. In most of the countries explored in this report, there is evidence that the criteria for resource allocation used by government or its agencies in the health sector values life significantly lower than the other non-health departments. The authors present a theoretical model which suggests that the existence of different values of life across departments is not inconsistent with the idea of optimal resource allocation (in a static model) but only if perfectly counterbalanced by non-health attributes. Notably, some form of reconciliation is needed to correct the potential imbalance in the value of the same attribute (life) across public sectors. Reconciliation could range from reallocation of budgets, transfers of benefit, to adjustments of benchmarking thresholds.
The COVID-19 pandemic has revealed the broad and devastating health, economic and societal impact of a highly infectious and deadly disease. In addition to the human suffering of COVID-19 patients, the pandemic is taking a heavy toll patients’ families, friends, colleagues, and other social networks. On healthcare staff working around the clock, wave after wave. And on the capacity of the NHS, buckling under the pandemic pressures with consequences that will last for years. Then, there’s the disastrous economic impact, crippling economies in the UK and worldwide.
Towse, A., Lothgren, M., Steuten, L. and Bruce, A.
Using medicines in combination can deliver better outcomes for patients across different tumour types and disease stages. Yet many HTA agencies do not find that the expected additional benefits from adding a new medicine to a currently reimbursed medicine represents value for money to the health system. In markets that utilise cost-per-QALY approaches for assessing value, a clinically effective medicine might even be found to be “not cost-effective at zero price” when used as part of a regimen that increases treatment duration.
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.