Valuing the Societal Impact of Medicines and Other Health Technologies: A User Guide to Current Best Practices

Abstract

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.

Keywords: cost-effectiveness analysis; generalized cost-effectiveness analysis; health technology assessment; value assessment.

Appendix Figure 1:

Conceptual Example of Insurance Value

Figure 1:

Generalized Cost Effectiveness Value Flower

Figure 2:

Evolution of the GCEA value flower

Figure 3:

Conceptual Representation of Outcome Certainty and Certainty Equivalence

Figure 4:

Conceptual Representation of Disease Risk Reduction

Figure 5:

Percentage of treatment duration (15 years) that each patient cohort takes the generic drug in the 70-year model

Figure 6:

Conceptual Differences in Real Option Value Methods

Figure 7:

Forecasting Innovation for Ex-Ante Option Value

Figure 8:

Overview of implementing family and caregiver spillover into GCEA.

Figure 9:

Overview of implementing community spillover into GCEA.

Figure E.1:

GCEA value flower