Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Jul 13:14:1197259.
doi: 10.3389/fphar.2023.1197259. eCollection 2023.

Reconstructing the value puzzle in health technology assessment: a pragmatic review to determine which modelling methods can account for additional value elements

Jeffrey M Muir  1 , Amruta Radhakrishnan  1 , Andreas Freitag  2 , Ipek Ozer Stillman  3 , Grammati Sarri  2
Affiliations
Review

Reconstructing the value puzzle in health technology assessment: a pragmatic review to determine which modelling methods can account for additional value elements

Jeffrey M Muir et al. Front Pharmacol. .

Abstract

Health technology assessment (HTA) has traditionally relied on cost-effectiveness analysis (CEA) as a cornerstone of evaluation of new therapies, assessing the clinical validity and utility, the efficacy, and the cost-effectiveness of new interventions. The current format of cost-effectiveness analysis, however, does not allow for inclusion of more holistic aspects of health and, therefore, value elements for new technologies such as the impact on patients and society beyond its pure clinical and economic value. This study aimed to review the recent modelling attempts to expand the traditional cost-effectiveness analysis approach by incorporating additional elements of value in health technology assessment. A pragmatic literature review was conducted for articles published between 2012 and 2022 reporting cost-effectiveness analysis including value aspects beyond the clinical and cost-effectiveness estimates; searches identified 13 articles that were eligible for inclusion. These expanded modelling approaches mainly focused on integrating the impact of societal values and health equity in cost-effectiveness analysis, both of which were championed as important aspects of health technology assessment that should be incorporated into future technology assessments. The reviewed cost-effectiveness analysis methods included modification of the current cost-effectiveness analysis methodology (distributional cost-effectiveness analysis, augmented cost-effectiveness analysis, extended cost-effectiveness analysis) or the use of multi-criteria decision analysis. Of these approaches, augmented cost-effectiveness analysis appears to have the most potential by expanding traditional aspects of value, as it uses techniques already familiar to health technology assessment agencies but also allows space for incorporation of qualitative aspects of a product's value. This review showcases that methods to unravel additional value elements for technology assessment exist, therefore, patient access to promising technologies can be improved by moving the discussion from "if" to "how" additional value elements can inform decision-making.

Keywords: cost-effectiveness analysis; health equity; health policy; health technology assessment; societal value; value elements.

PubMed Disclaimer

Conflict of interest statement

Authors JM, GS, AR, and AF were employed by Cytel, Inc. Author IO was employed by Takeda Pharmaceuticals, Inc.

Figures

FIGURE 1
FIGURE 1
PRISMA diagram detailing literature search results and subsequent review process.
FIGURE 2
FIGURE 2
The “Value Puzzle” illustrates the existing aspects of CEA (clinical efficacy, economic value, disease modifiers and unmet treatment needs) but also highlights the missing aspects of the current system (health equity and societal values).
FIGURE 3
FIGURE 3
Overview of approaches recommended in the literature.
See this image and copyright information in PMC

References

    1. Angelis A., Kanavos P. (2017). Multiple criteria decision analysis (MCDA) for evaluating new medicines in health technology assessment and beyond: The advance value framework. Soc. Sci. Med. 188, 137–156. 10.1016/j.socscimed.2017.06.024 - DOI - PubMed
    1. Asaria M., Griffin S., Cookson R. (2016). Distributional cost-effectiveness analysis: A tutorial. Med. Decis. Mak. 36 (1), 8–19. 10.1177/0272989X15583266 - DOI - PMC - PubMed
    1. Baltussen R., Jansen M. P. M., Bijlmakers L., Grutters J., Kluytmans A., Reuzel R. P., et al. (2017). Value assessment frameworks for HTA agencies: The organization of evidence-informed deliberative processes. Value Health 20 (2), 256–260. 10.1016/j.jval.2016.11.019 - DOI - PubMed
    1. Baltussen R., Marsh K., Thokala P., Diaby V., Castro H., Cleemput I., et al. (2019). Multicriteria decision analysis to support health technology assessment agencies: Benefits, limitations, and the way forward. Value Health 22 (11), 1283–1288. 10.1016/j.jval.2019.06.014 - DOI - PubMed
    1. Benkhalti M., Espinoza M., Cookson R., Welch V., Tugwell P., Dagenais P. (2021). Development of a checklist to guide equity considerations in health technology assessment. Int. J. Technol. Assess. Health Care 37, e17. 10.1017/S0266462320002275 - DOI - PubMed

LinkOut - more resources