HT3 What is Value? A Systematic Review of Value Assessment Frameworks


      To investigate how value is defined and measured in existing value assessment frameworks (VAFs) in health care.


      We searched PubMed, Embase, the Cochrane Library and Centre for Review and Dissemination from 2008 to 2019. We also performed backward citation chaining of included studies and previously published systematic reviews. Studies reporting the development of a VAF in health care were included. For each included framework, we extracted and compared the context, target users, intended use, methods used to identify value attributes (e.g., patient/public engagement), description of the attributes, and attribute scoring approaches.


      Out of 8151 articles screened, 53 VAFs described in 56 articles were included. The value attributes included in 52 VAFs were grouped into nine categories, namely, health benefits (50/52, 96%), affordability (42/52, 81%), societal impact (39/52, 75%), the burden of disease (35/52, 67%), quality of evidence (31/52, 60%), cost-effectiveness (30/52, 58%), ethics and equity (25/52, 48%), unmet needs (22/52, 42%), and innovation (15/52, 29%). The remaining VAF uses three broad attributes for diagnostics: medical value, planning value and psychic value. Literature review has been used to identify value attributes in 34 VAFs. Patient/public was engaged in the development of only 11 VAFs. Weighting has been used to score 29 VAFs, among which 19 used the methods of multicriteria decision analysis (MCDA).


      Substantial efforts have been made to facilitate value assessment in health care. There are substantial variations in defining and measuring value. A particular concerning finding is that patient/public engagement was poor in this process.