Value, Affordability, and Decision Making

A team at the University of York recently published a study in which they sought to generate more reliable evidence to inform the estimation of marginal productivity in the NHS. In our response, published in Medical Decision Making, we suggest that, unfortunately, the estimates provided by the ‘experts’ in the study are of little practical use.

In this blog, we reflect on some of the key learnings from the recent pull and push strategies to develop COVID-19 vaccines in the UK, the US, and the European Union. We use our recent work on portfolio management, pricing, and procurement of COVID-19 vaccines (forthcoming as an OHE report) to organise the review.

A new paper explores the equivalence of Multi-Criteria Decision Analysis and Augmented Cost-Effectiveness Analysis in adding elements of value to QALY-based cost-effectiveness decision making. It finds that they are equivalent methods under reasonable assumptions when elements of value can be aggregated into two separate top-level groups: health and financial.

In the contentious debate around US drug prices, less well understood is: if the price of a drug is a fair, value-based, price, how we assess if insurance coverage provides patients with ‘fair access’ to that drug? This paper from ICER and OHE authors seeks to define fair access. It proposes Ethical Goals for Access and Fair Design Criteria for cost-sharing and prior authorisation protocols.

A new Editorial reviews three solutions to the price and value challenge to reimbursing combination products. Higher thresholds are not justifiable. Evidence to support use of shorter regimens will take time to develop. Multi-use pricing is the best option to explore.

This blog summarises an initiative taken by more than 300 health economists and experts in support of the creation of an independent health technology assessment agency in Spain.

This research paper examines whether value of a life estimates used in economic evaluation differs between government departments in a selection of developed countries. The authors find that generally estimates used in transport and the environment exceeded those used in health, which suggests that health may be undervalued by departments of health compared to departments of transport or environment.

Cubi-Molla, P., Mott, D., Henderson, N., Zamora, B., Grobler, M. & Garau, M. 

Research Paper
February 2021

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.

Brassel, S., Neri, M. and Steuten, L. 

Consulting Report
February 2021

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.

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.


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