Patient and Payer Preferences for Additional Value Criteria

Abstract

Background: Defining the value of healthcare is an elusive target, and depends heavily on the decision context and stakeholders involved. Cost-utility analysis and the quality-adjusted life year (QALY) have become the method and value definition of choice for traditional value judgements in coverage and pricing decisions. Other criteria that may influence value are often not measured and therefore omitted from value assessments, or are only used to qualitatively contextualize assessments. The objective of this study was to engage two key stakeholders; patients and payers to elicit and rank the importance of additional value criteria, potentially assessed in Multiple Criteria Decision Analysis (MCDA). Methods: This study consisted of a focus group with cancer patients (n = 7), including follow-up questions through an electronic survey, and in-depth phone interviews with payers (n = 5). Results: For payers, value equated either with criteria that provided tangible benefits (from their perspective) such as new treatment options that respond to serious unmet need. For patients, population-level value equated to options that would potentially benefit them in the future and the value of hope. However, these criteria were seen by payers as difficult to measure and incorporate into objective decision making. Limitations: The findings from this study are primarily limited due to generalizability. Due to the small sample size, it was outside the scope of this study to calculate a weight for each criterion that could be used as part of a quantitative MCDA. Conclusion: MCDA, with particular attention to qualitative aspects, is an avenue to incorporate these additional criteria into value assessments, as well as provide an opportunity for reflecting the patient's preferences in assessing the value of a treatment.

Keywords: Multiple Criteria Decision Analysis; health technology assessement; patient; payer; value.

FIGURE 1

Structure of the research phases and aims.

FIGURE 2

Extracted value criteria from United States value frameworks and the list of proposed Additional Value Criteria after the iterative phase. Institute for Clinical and Economic Review (ICER); International Society for Pharmacoeconomics and Outcomes Research (ISPOR) now known as The Professional Society for Health Economics and Outcomes Research; Memorial Sloan Kettering Cancer Center (MSKCC). *Value criteria deem by the research team as traditionally (not necessarily systematically) assessed are bolded and underlined.