Abstract
Objectives
Since its publication as part of the 2018 ISPOR Special Task Force (STF) on US Value
Assessments, the “ISPOR value flower,” with its petals highlighting elements that
may be overlooked or underappreciated in conventional drug value assessments, has
been discussed and debated. We review the history of the value flower, describe recent
developments, and consider implications for future value assessments.
Methods
We discuss various antecedents to the value flower, as well as conceptual and empirical
articles published in the past 4 years.
Results
Since the publication of the ISPOR STF report, researchers have provided more rigorous
theoretical and mathematical foundations for certain novel value elements (eg, severity
of illness, value of insurance, value of hope) through “generalized risk-adjusted
cost-effectiveness analysis,” which incorporates risk aversion in people’s preferences
and uncertainty in treatment outcomes. Empirical estimates are also emerging to support
key elements, such as insurance value, real option value, value of hope, and value
of knowing. Although health technology assessment bodies have applied or are considering
certain elements (eg, severity modifiers to cost-effectiveness thresholds), other
elements have yet to gain traction.
Conclusions
Five years after the STF began its work, the development of novel value measures continues
to evolve. Although it is encouraging to see supporting empirical studies emerging,
more are needed. Additional efforts are also needed to illustrate how the estimates
can be used in the deliberative processes that are integral to health technology assessments.
Keywords
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References
- A health economics approach to US value assessment frameworks-introduction: an ISPOR Special Task Force report [1].Value Health. 2018; 21: 119-123
- A health economics approach to US value assessment frameworks-summary and recommendations of the ISPOR Special Task Force report [7].Value Health. 2018; 21: 161-165
- Second Panel on Cost-Effectiveness in Health and Medicine.Oxford University Press, Oxford, United Kingdom2016
- An overview of value, perspective, and decision context—a health economics approach: an ISPOR Special Task Force report [2].Value Health. 2018; 21: 124-130
- Linking pharmacogenetics-based diagnostics and drugs for personalized medicine.Health Aff (Millwood). 2006; 25: 1281-1290
- The economics of personalized medicine: a model of incentives for value creation and capture.Drug Inf J. 2007; 41: 501-509
- Knowing for the sake of knowing: the value of prognostic information.Med Decis Making. 1990; 10: 47-57
- Willingness-to-pay for predictive tests with no immediate treatment implications: a survey of US residents.Health Econ. 2012; 21: 238-251
- The value of knowing and knowing the value: improving the health technology assessment of complementary diagnostics. Office of Health Economics, EPEMED.(Accessed March 4, 2022)
- Economic foundations of cost-effectiveness analysis.J Health Econ. 1997; 16: 1-31
- Real option value and path dependence in oncology innovation.Int J Econ Bus. 2011; 18: 225-238
- How cancer patients value hope and the implications for cost-effectiveness assessments of high-cost cancer therapies.Health Aff (Millwood). 2012; 31: 676-682
- The insurance value of medical innovation.J Public Econ. 2017; 145: 94-102
- Toward a broader concept of value: identifying and defining elements for an expanded cost-effectiveness analysis.Value Health. 2017; 20: 213-216
- Defining elements of value in health care—a health economics approach: an ISPOR Special Task Force report [3].Value Health. 2018; 21: 131-139
- Can and should value-based pricing be applied to molecular diagnostics?.Pers Med. 2013; 10: 61-72
Garau M, Towse A. Assessment of Co-Dependent Technologies. Presentation in Issues Panel “How Do You Assess the Value of Codependent Technologies?” ISPOR, Office of Health Economics. https://www.slideshare.net/OHENews/implications-of-codependent-technologies-in-medicine. Accessed March 4, 2022.
- Review of recent US value frameworks—a health economics approach: an ISPOR Special Task Force report [6].Value Health. 2018; 21: 155-160
- The Right Price: A Value-Based Prescription for Drug Costs.Oxford University Press, Oxford, United Kingdom2021
- Value Based Pricing in Sweden: Lessons for Design? Office of Health Economics.(Accessed March 4, 2022)
- SMC modifiers used in appraising new medicines. Scottish Medicines Consortium.https://www.scottishmedicines.org.uk/media/3565/modifiers.pdfDate accessed: December 20, 2021
- CHTE methods review. Modifiers: Task and finish group report. National Institute for Health and Care Excellence.(Accessed March 4, 2022)
NICE health technology evaluations: the draft manual. https://www.nice.org.uk/Media/Default/About/what-we-do/our-programmes/nice-guidance/chte-methods-and-processes-consultation/health-technology-evaluations-manual.docx. Accessed October 1, 2021.
- ICER value framework 2020 update: recommendations on the aggregation of benefits and contextual considerations.Value Health. 2020; 23: 1040-1048
Watkins JB, Tsiao E, Premera Blue Cross, Pharmacy and Therapeutics Committee, 2019.
- New approaches to value assessment: towards more informed pricing in healthcare—an introduction.Value Health. 2019; 22: S1-S3
- Novel approaches to value assessment beyond the cost-effectiveness framework.Value Health Reg Issues. 2019; 22: S18-S23
- Health technology assessment with risk aversion in health [published correction appears in J Health Econ. 2021;78:102474].J Health Econ. 2020; 72102346
- Health technology assessment with diminishing returns to health: the generalized risk-adjusted cost-effectiveness (GRACE) approach.Value Health. 2021; 24: 244-249
Lakdawalla DN, Phelps CE. A guide to extending and implementing generalized risk-adjusted cost-effectiveness (GRACE) [published online September 8, 2021]. Eur J Health Econ. https://doi.org/10.1007/s10198-021-01367-0.
Phelps CE, Lakdawalla DN. The generalized and risk-adjusted cost effectiveness (GRACE) methodology: overview and implementation. Oxford, United Kingdom: Oxford University Press; Forthcoming.
- Quality-adjusted life years and the devaluation of life with disability. National Council on Disability.(Accessed March 4, 2022)
- Does framing of cancer survival affect perceived value of care? A willingness-to-pay survey of US residents.Expert Rev Pharmacoecon Outcomes Res. 2013; 13: 513-522
- 2020-2023 value assessment framework. Institute for Clinical and Economic Review.(Accessed March 4, 2022)
- Novel elements of the value flower: fake or truly novel? Value Outcomes Spotlight ISPOR.(Accessed March 4, 2022)
- Patient variability seldom assessed in cost-effectiveness studies.Med Decis Making. 2018; 38: 487-494
- Extended cost-effectiveness analysis for health policy assessment: a tutorial.Pharmacoeconomics. 2016; 34: 913-923
- Using cost-effectiveness analysis to address health equity concerns.Value Health. 2017; 20: 206-212
- Distributional Cost-Effectiveness Analysis. Quantifying Health Equity Impacts and Trade-Offs.Oxford University Press, Oxford, United Kingdom2020
Husereau D, Drummond M, Augustovski F, et al. Consolidated health economic evaluation reporting standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations. Value Health. In press.
- Do cost-effectiveness analyses account for drug genericization? A literature review and assessment of implications.Value Health. 2022; 25: 59-68
- Augmenting cost-effectiveness analysis for uncertainty: the implications for value assessment-rationale and empirical support.J Manag Care Spec Pharm. 2020; 26: 400-406
- Measuring the value healthy individuals place on generous insurance coverage of severe diseases: a stated preference survey of adults diagnosed with and without lung cancer.Value Health. 2021; 24: 855-861
- Measuring “fearonomic effects” in valuing therapies: an application to COVID-19 in China.Value Health. 2020; 23: 1405-1408
- Patient versus physician valuation of durable survival gains: implications for value framework assessments.Value Health. 2017; 20: 217-223
- Quantifying value of hope.Value Health. 2021; 24: 1511-1519
- The option value of Innovation.Forum Health Econ Policy. 2012; 1520122005
- Do cancer treatments have option value? Real-world evidence from metastatic melanoma.Health Econ. 2019; 28: 855-867
- How does option value affect the potential cost-effectiveness of a treatment? The case of ipilimumab for metastatic melanoma.Value Health. 2019; 22: 777-784
- Broadening the concept of value: a scoping review on the option value of medical technologies.Value Health. 2021; 24: 1045-1058
- The option value of innovative treatments for non-small cell lung cancer and renal cell carcinoma.Am J Manag Care. 2017; 23: e340-e346
- The option value of innovative treatments for metastatic melanoma.Forum Health Econ Policy. 2018; 2120160014
- Real-world evidence for option value in metastatic melanoma.J Manag Care Spec Pharm. 2021; 27: 1546-1555
- Modeling the ex post real option value in metastatic melanoma using real-world data.Value Health. 2021; 24: 1746-1753
- Value-based pricing for emerging gene therapies: the economic case for a higher cost-effectiveness threshold.J Manag Care Spec Pharm. 2019; 25: 793-799
- An exploratory case study of the impact of expanding cost-effectiveness analysis for second-line nivolumab for patients with squamous non-small cell lung cancer in Canada: does it make a difference?.Health Policy. 2018; 122: 607-613
- The impact of social and novel elements on cost-effectiveness analysis: two case studies.Value Health. 2021; 24: S147
- How excluding some benefits from value assessment of new drugs impacts innovation.Health Econ. 2017; 26: 1813-1825
- Perspective and costing in cost-effectiveness analysis, 1974-2018.Pharmacoeconomics. 2020; 38: 1135-1145
- Patient adherence: a blind spot in cost-effectiveness analyses?.Am J Manag Care. 2009; 15: 626-632
- Expanding the scope of costs and benefits for economic evaluations in health: some words of caution.Pharmacoeconomics. 2019; 37: 457-460
- Health technology assessment in the U.S.—a vision for the future. USC Schaeffer Center.(Accessed March 4, 2022)
Article info
Publication history
Published online: March 09, 2022
Accepted:
January 13,
2022
Identification
Copyright
© 2022 International Society for Pharmacoeconomics and Outcomes Research, Inc. Published by Elsevier Inc.
