Abstract
Health Technology Assessment is increasingly used to evaluate the value of healthcare products and to prioritize resources; however, defining exactly what value is and how it should be measured remains a challenge. In this article, we report the results of a literature review, focusing on nine European countries, with the aim of investigating how value is defined from the perspective of different stakeholders, how definitions of value are used, and how value is incorporated into decision making. Only three articles were identified that presented definitions of value, and there was no single shared definition of value in healthcare, which appears to be a highly subjective concept. The majority of the countries investigated combine clinical assessment with economic evaluation to make reimbursement recommendations; the quality-adjusted life-year is the most commonly used measure of value but does not capture broader aspects of value that may be important to patients and healthcare systems. We describe the use of value-based pricing and multi-criteria decision analysis, two approaches to the incorporation of broader aspects of value into decision making. Overall, we have identified considerable variation in how a product’s value is defined by different stakeholders. Although a universal understanding of value in healthcare is important, it is clear that current definitions are insufficient, potentially leading to inconsistent reimbursement decisions. Ultimately, the establishment of clearer policies for defining and measuring value in healthcare is needed, and is likely to lead to improvements in the consistency of decision making.
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Acknowledgments
The literature review was conducted by Marieke Schurer and Ann-Marie Chapman (BresMed Health Solutions Ltd, Sheffield, UK). Editorial assistance in the preparation of this article was provided by Paul Overton (independent medical writer), who had no involvement in the design or conduct of the literature review. The authors would like to thank the anonymous reviewers for their helpful comments and suggestions.
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Fernando Antoñanzas, Robert Terkola and Maarten Postma designed the study, analyzed the results, reviewed all draft versions of the manuscript, and approved the final version for submission.
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Research and editorial support was funded by Novartis Pharma, Basel, under the AGORA initiative (a European Think Tank that aims to optimize access for patients to innovative treatments).
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All authors have received honoraria and travel support related to this study from Novartis Pharma, Basel, under the AGORA initiative. Maarten Postma has received research grants and honoraria from various pharmaceutical companies, which are unrelated to this study.
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Antoñanzas, F., Terkola, R. & Postma, M. The Value of Medicines: A Crucial but Vague Concept. PharmacoEconomics 34, 1227–1239 (2016). https://doi.org/10.1007/s40273-016-0434-8
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DOI: https://doi.org/10.1007/s40273-016-0434-8