The variability of value
By: John Doyle, DrPH, MPH | May 23, 2016
Value frameworks could offer useful insight into the benefits of different treatments, but lack of consistency may limit their use.
Defining value has always been a complicated proposition, especially when different stakeholders have different definitions of value. In the world of biopharma, one stakeholder may place greater value on affordability, while another is more concerned about side effects, or efficacy in comparison to other products. These differing views make it difficult to definitively define the value of any product, or to compare like products, and this is becoming a concern. As the industry moves toward a value-based healthcare economy, we need to figure how to measure the different value propositions of treatments and medical devices, and to communicate those combined results in clear and meaningful metrics.
Several healthcare organizations are trying to achieve this goal through the development of value frameworks that assess multiple features of treatments and devices to generate scores, grades or ratings of value. These frameworks are intended to create greater transparency and clarity around the benefit of various treatment options for regulators, payers, Health Technology Assessment boards (HTAs), physicians and patients so that they can make more informed decisions.
At this year’s International Society For Pharmacoeconomics And Outcomes Research (ISPOR) meeting in May, our team is presenting a workshop analyzing the heterogeneity of outputs from four recently developed oncology value frameworks: the American Society of Clinical Oncology’s (ASCO) Value Framework, the National Comprehensive Cancer Network’s (NCCN) Evidence Blocks, Memorial Sloan Kettering Cancer Center’s (MSKCC) DrugAbacus, and the Institute for Clinical and Economic Review’s (ICER) Value Assessment Framework.
Different tools, different results
In the workshop we will look at how these frameworks work and we will discuss their strengths, limitations, and heterogeneity. One of the benefits of the ASCO Value Framework, for example, is that it is simplified for patients so that they can review outcomes represented as a single score and costs, but net health benefit scores are not comparable for multiple treatments using this tool. In comparison, NCCN’s Evidence Blocks rank five value features so users can compare multiple aspects of value, but the simplified 1-5 scoring system narrows the degree of distinction between drugs. And one of the major benefits of DrugAbacus is that it allows users to adjust emphasis levels based on those value factors they deem most important, but it is difficult to compare drugs head-to-head using this tool. Finally, ICER’s Value Assessment Framework was designed to address the need for more transparency around how value determinations are made by payers and HTA bodies; however, the Framework’s limited time horizon may undervalue the long-term benefits and cost offsets of therapies for chronic diseases.
The differences between the tools also produces surprising variability in results for the same cancer treatments. Depending on which tool a stakeholder uses, they may get a vastly different sense of which treatment options will generate the best value. To demonstrate this variability in the workshop, we will use the frameworks to evaluate three hypothetical drug profiles, generated specifically to illustrate an array of scores that the frameworks generate for identical drugs.
This variability is not unexpected as we are in the early days of building value frameworks and determining how best to quantify value, but it is concerning. The increased scrutiny of drug prices will likely lead to the use of value-based frameworks as guideposts for drug costs, and major payers have already begun to acknowledge the potential utility of value-based frameworks for coverage decisions. That means biopharma industry leaders may soon rely on these frameworks to communicate the value of their products, and if each one generates a different value profile it will be difficult to decide which outputs to measure, which evidence to collect, and how best to communicate the value of these products to stakeholders.
Our hope is that this workshop will spur conversations among industry organizations about the potential benefits of these frameworks as well as the opportunities we have now to improve upon them. Having frameworks that quantify the value of treatments will be useful to everyone in the healthcare economy, but only if they are fair, consistent, and meaningful to the stakeholders who use them.