A User Guide to Current Best Practices – Healthcare Economist

That is the title of a new publication with co-authors Joshua T. Cohen, Louis P. Garrison, Dana A. Goldman, Jalpa A. Doshi, Joshua Krieger, Darius N. Lakdawalla, Peter J. Neumann, Charles E. Phelps, Melanie D. Whittington and Richard Willke. This consensus paper aims to provide researchers with a user guide for estimating broader societal value elements as part of health technology assessment. The paper takes the recommendations from the ISPOR Value Flower and Second Panel of Cost Effectiveness in Health and Medicine and expands them in to an overarching framework. Moreover, the paper provides useful tips for how to empirically estimate each of the broader value elements. The full abstract is below.

This study argues that value assessment conducted from a societal perspective should rely on the Generalized Cost-Effectiveness Analysis (GCEA) framework proposed herein. Recently developed value assessment inventories – such as the Second Panel on Cost-Effectiveness’s “impact inventory” and International Society of Pharmacoeconomics Outcomes Research (ISPOR) “value flower” – aimed to more comprehensively capture the benefits and costs of new health technologies from a societal perspective. Nevertheless, application of broader value elements in practice has been limited in part because quantifying these elements can be complex, but also because there have been numerous methodological advances since these value inventories have been released (e.g. generalized and risk-adjusted cost effectiveness). To facilitate estimation of treatment value from a societal perspective, this paper provides an updated value inventory – called the GCEA value flower – and a user guide for implementing GCEA for health economics researchers and practitioners. GCEA considers 15 broader value elements across four categories: (i) uncertainty, (ii) dynamics, (iii) beneficiary, and (iv) additional value components. The uncertainty category incorporates patient risk preferences into value assessment. The dynamics category petals account for the evolution of real-world treatment value (e.g. option value) and includes drug pricing trends (e.g. future genericization). The beneficiary category accounts for the fact health technologies can benefit others (e.g. caregivers) and also that society may care to whom health benefits accrue (e.g. equity). Finally, GCEA incorporates additional broader sources of value (e.g. community spillovers, productivity losses). This GCEA user guide aims to facilitate both the estimation of each of these value elements and the incorporation of these values into health technology assessment when conducted from a societal perspective.

You can read the full paper here.

While I would love people to read this article from start to end, the full article weighs in at 88 pages. What most people likely will do is to think about a value element they would like to estimate, and then go to that section. For each petal of the GCEA value flower, there is a 2-5 page write-up that (i) defines the value element, (ii) describes the key steps to calculate it, (iii) identify key parameters from the literature needed to estimate this value, (iv) provides a simple example of how to measure, and (v) identify any limitations of the recommended approach. We believe that this document really should be seen as the user guide for empirically quantifying broader societal value of new health technologies. Let me know your thoughts!