What Is Value in Health and Healthcare? A Systematic Literature Review of Value Assessment Frameworks

Using a lottery to resolve indeterminacy when allocating resources for drugs for rare diseases

Healthcare resource allocation decisions for high-cost drugs for rare diseases (DRDs) raise several challenges for decision makers, and, given the complexity of the decisions and the limited funding available for DRDs, it is reasonable to anticipate indeterminacy arising about which DRDs to fund. We argue that when indeterminacy does arise, one might consider resolving it by using a lottery. We examine the extent to which a lottery and the commonly used process of first come, first served satisfy the requirements of formal equality and several substantive and procedural values. We then examine two practical issues that arise when implementing a lottery, identifying the lottery participants and determining what happens to the 'losers' of a lottery, to examine the extent to which various ethical issues are raised by these practical decisions. We conclude that, while lotteries may not be used frequently to allocate healthcare resources, at least under the conditions outlined here, a random selection process has a morally justified role in allocating funding for DRDs and may sometimes be preferable to first come, first served.

How is Value Defined in Molecular Testing in Cancer? A Scoping Review

OBJECTIVE

To identify how value is defined in studies that focus on the value of molecular testing in cancer and the extent to which broadening the conceptualisation of value in healthcare has been applied in the molecular testing literature.

METHODS

A scoping review was undertaken using Joanna Briggs Institute (JBI) guidance. Medline, Embase, EconLit and Cochrane Library were searched in August 2023. Articles were eligible if they reported costs relative to outcomes, novel costs, or novel outcomes of molecular testing in cancer. Results were synthesised and qualitative content analysis was performed with deductive and inductive frameworks.

RESULTS

Ninety-one articles were included in the review. The majority (75/91) were conventional economic analyses (comparative economic evaluations and budget impact assessments) and undertaken from a healthcare system perspective (38/91). Clinical outcomes dominate the assessment of value (61/91), with quality-adjusted life-years (QALYs) the most common outcome measure (45/91). Other definitions of value were diverse (e.g. psychological impact, access to trials), inconsistent, and largely not in keeping with evolving guidance.

CONCLUSIONS

Broader concepts of value were not commonly described in the molecular testing literature focusing on cancer. Conventional approaches to measuring the health costs and outcomes of molecular testing in cancer prevail with little focus on non-clinical elements of value. There are emerging reports of non-clinical outcomes of testing information, particularly psychological consequences. Intrinsic attributes of the testing process and preferences of those who receive testing information may determine the realised societal value of molecular testing and highlight challenges to implementing such a value framework.

A perspective on the use of patient-reported experience and patient-reported outcome measures in ambulatory healthcare

INTRODUCTION

Patient-reported experience measures (PREMs) are patient reports about their healthcare, whereas patient-reported outcome measures (PROMs) are reports about their functioning and well-being regarding physical, mental, and social health. We provide a perspective on using PREMs and PROMs in ambulatory healthcare.

AREAS COVERED

We conducted a narrative review of the literature about using PREMs and PROMs in research and clinical practice, identified challenges and possibilities for addressing them, and provided suggestions for future research and clinical practice.

EXPERT OPINION

Substantial progress in using PREMs and PROMs has occurred during the last half-century. Collecting and reporting PREMs to clinicians in ambulatory care settings has improved communication with patients, diagnosis, and treatment, which may improve patients' health. Optimal use requires appropriate data analysis, minimizing implementation barriers, and facilitating interpretation of PREMs and PROMs in clinical practice. Also, formal structures and processes that include patient and family input into care improvement are needed (e.g. patient and family advisory councils as partners in co-design and coproduction of quality improvement). PREMs and PROMs have been used primarily in more affluent countries (e.g. the United States, Australia, United Kingdom, Netherlands, Japan, and Portugal), but this is expected to increase in many countries.

Understanding healthcare efficiency-an AI-supported narrative review of diverse terminologies used

BACKGROUND

Physicians have become more responsible for pursuing healthcare efficiency. However, contemporary literature uses multiple terminologies to describe healthcare efficiency. To identify which term is best suitable for medical education to equip physicians to contribute to healthcare efficiency delivery in clinical practice, we performed a narrative review to elucidate these terms' meanings, commonalities, and differences.

METHODS

The PubMed-database was searched for articles published in 2019-2024 describing healthcare efficiency terminology. Eligible articles conceptually described and applied relevant terminologies for physicians, while empirical studies and practice-specific articles were excluded. The screening was supported by an open-source artificial intelligence tool (ASReview), which prioritizes articles through machine learning. Two reviewers independently screened the resulting articles, resolving disagreements by consensus. Final eligibility was determined through predefined inclusion criteria.

RESULTS

Out of 3,655 articles identified, 26 met the inclusion criteria. Key terminologies: cost-effectiveness, high-value care, low-value care, and value-based healthcare, were identified, and explored into more depth. 'Value' is central in all terms, but our findings reveal that the perspectives herein differ on what constitutes value. Within cost-effectiveness, resource allocation to the population's needs drives decision-making-maximizing value at population-level. Within value-based healthcare, patient-centricity guides decision-making-maximizing value at individual patient-level. High-value and low-value care are somewhat ambiguous, depending solely on cost-effectiveness results or patient preferences to determine whether care is considered as low or high value.

CONCLUSIONS

Cost-effectiveness may be too rigid for patient-physician interactions, while value-based healthcare might not ensure sustainable care. As physicians are both stewards of finite societal resources and advocates of individual patients, integrating cost-effectiveness (resource allocation for population needs) and value-based healthcare (individualized care plans) seems necessary. Both terms emphasize delivering high-value care and avoiding low-value care. We suggest that medical education: (1) train (future) physicians to apply healthcare efficiency principles through case-based discussion, (2) use the cost-effectiveness plane to evaluate treatments, (3) deepen knowledge of diagnostic and treatment procedures' costs within evidence-based guidelines, and (4) enhance communication skills supporting a healthcare efficiency-driven open shared decision-making with patients.

The Concept of Personal Utility in Genomic Testing: Three Ethical Tensions

Health Technology Assessment (HTA) has traditionally focused on efficacy, safety, and cost-effectiveness. There has long been concern, however, that this is determined by the goals of healthcare providers/payers, not patients. As a result, HTA arguably fails to reflect the overall value of health technologies-including their "non-clinical" or "personal" utility to patients and their families. The use of genomic testing in clinical care is one domain where this problem is evident, as the personal utility of results is often especially significant. As such, there are growing calls for HTA frameworks to adopt personal utility as a distinct element of value when assessing clinical genomic tests. We agree that personal utility is important to HTA in clinical genomics. However, against a trend toward comprehensive conceptions of personal utility within HTA, we advocate for a restrictive approach to assessing the value of personal utility in the case of clinical genomic testing.

Defining the value proposition in diagnostic technology: challenges and opportunities for its understanding and development - a review with a multiperspective reflective analysis

Background

The Value Proposition (VP) in diagnostic technology serves as a "positioning statement" outlining the unique benefits, costs, and differentiation an innovation under development offers to healthcare organizations and its ability to effectively deliver these advantages in comparison to current interventions in the market. Despite its significance however, VP lacks a universally accepted definition, which is compounded by the diversity of technologies, their applications, and the varying needs of stakeholders. This paper aims to address this gap by offering a detailed conceptual analysis, revised definition of VP, and actionable recommendations for advancing VP development.

Methodology

We conducted a targeted narrative review, focusing on literature explicitly defining VPs in diagnostic technologies. Using Ovid's Medline and Embase databases, we identified 19 relevant papers, of which only 5 provided explicit VP definitions. Our analysis incorporated principles of team science, encompassing reflective and thematic analyses of (1) interdisciplinary co-author discussions enabling us to weave together diverse insights into a cohesive exploration of the topic, and (2) MTech's publicly available set of anonymised responses from NHS Associates, to capture the perspectives of the decision-makers and further enhance depth and breadth of our discourse.

Results and discussion

Our findings highlight the multifaceted nature of VP and its primary hurdles: inadequate identification of unmet needs and insufficient recognition of key stakeholders. We synthesized the evolution of VP definitions and explored the importance of unmet needs in their development, guided by frameworks, such as the Health Technology Navigation Pathway Tool, to ensure VPs meet both the pragmatic and aspirational goals of the healthcare. Thematic insights revealed opportunities for addressing these barriers through implementation science and collaborative strategies. This multi-perspective approach provided a conceptual examination of VP, enabling integration of varied viewpoints and insights.

Conclusion

By employing team science principles and reflective analysis, we introduced a revised definition of VP and a set of actionable recommendations to guide VP development in diagnostics. These findings highlight the importance of addressing stakeholder diversity, unmet needs, and the intricacies of blending interdisciplinary perspectives to advance the field.

Transforming Healthcare Through Value: A Fiscal Perspective on OECD Countries

Background

Escalating healthcare expenditures pose a significant challenge to global fiscal sustainability. Value-based healthcare offers a strategy to improve health outcomes while controlling costs. This study examines the fiscal impacts of value-based healthcare in OECD countries, providing evidence of its role in enhancing fiscal efficiency.

Methods

This study employs three key approaches. A value-based healthcare index was constructed using the entropy weight method to measure performance across 32 OECD countries from 2000 to 2019. Econometric analysis using panel data models explored the fiscal effects of value-based healthcare. Contextual examination further assessed the interactions between value-based healthcare and factors such as government health expenditure, population aging, and elderly disease burden.

Results

The results show that higher value-based healthcare performance improves budget balance, reduces debt burden, and enhances fiscal sustainability. Interaction effects highlight the importance of government health expenditure and demographic factors in influencing fiscal outcomes.

Conclusion

This study demonstrates the fiscal benefits of value-based healthcare, emphasizing its potential to address healthcare inefficiencies and promote sustainable public finances. Policymakers should integrate value-based healthcare principles into healthcare systems while considering country-specific contexts to maximize long-term impact.

Value Framework Based on Multiple-Criteria Decision Analysis for Assessment of New Health Technologies Under Universal Healthcare Coverage System in Taiwan

OBJECTIVES

Given the lack of a value framework for assessing health technologies in Asian settings, a value framework incorporating multiple-criteria decision analysis for new drugs under universal healthcare coverage in Taiwan was established.

METHODS

The development process included (1) the adoption of 5 value domains (ie, Overall clinical benefit, Disease burden, Alignment with patient concerns, Economic value, and Feasibility of adoption into the health system) and 26 corresponding indicators, derived from the literature and expert discussions; (2) the creation of separate weighting schemes for 3 drug types-new oncology, new orphan, and other new drugs-based on inputs from multiple stakeholders (n = 86) using various weighting methods; and (3) the application of the value framework to cases of new oncology drugs.

RESULTS

Overall clinical benefit had the highest preference weight, irrespective of drug type, (ie, mean values [95% CIs] for new oncology, new orphan, and other new drugs: 32.5 [30.4-34.6], 30.6 [28.1-33.1], and 30.6 [28.7-32.6], respectively), weighting method, and stakeholder type. The 5 domain-derived weights (from the point allocation method) were comparable to the 26 indicator-derived weights (from the direct rating method), suggesting that the value framework with a short-form (domain-derived) weighting scheme is sufficient to support decision making under time and resource constraints.

CONCLUSIONS

A country-specific value framework incorporating multiple-criteria decision analysis for new drugs was developed in an Asian setting under universal healthcare coverage. It allows multiple stakeholders to systematically appraise all drug value attributes and provides a structured process for adapting and refining value assessments.

What are the priorities of consumers and carers regarding measurement for evaluation in mental healthcare? Results from a Q-methodology study

BACKGROUND

The purpose of this study was to identify and describe common views of people with lived experience of mental health challenges - consumers and carers, families and supporters - of what they consider the most important measures to include in health economic evaluations which assess the incremental value of competing options in mental health care.

METHODS

Participants (n = 111) were people living in the state of Victoria, Australia, who identified as consumers of mental healthcare (n = 38); carers, family members and/or supporters (n = 43); or both (n = 30). Factor analysis based on Q-Methodology was used to identify clusters of people who hold similar viewpoints. Common viewpoints were described in terms of the characteristics of the group, and a qualitative interpretation was conducted on the basis of distinguishing statements and quotes provided in participants' own words.

RESULTS

We identified four common views: (1) safety before all else, prioritizing physical, sexual and psychological safety; (2) hope and partnership in processes of care; (3) physical and emotional health and wellbeing; and (4) care access, continuity and partnership with families. Although different priorities were identified for each viewpoint, key priority areas that were common to all views were having an environment in the health service that fosters respect and dignity, and that consumers feel heard and listened to. In sub-group and qualitative analyses, differences were observed regarding the likelihood of consumers and carers holding each of the views, as well as by age group.

CONCLUSIONS

While some differences were noted between the views of consumers and carers and different age groups, there was also common ground regarding what outcomes are of most importance to measure. Including these measures in evaluation frameworks would provide a way of focussing mental healthcare decisions on the aspects of mental healthcare that are of most value to consumers and carers, thereby addressing an important shortcoming of current approaches to decision-making in mental healthcare.

Unravelling Elements of Value of Healthcare and Assessing their Importance Using Evidence from Two Discrete-Choice Experiments in England

BACKGROUND

Health systems are moving towards value-based care, implementing new care models that allegedly aim beyond patient outcomes. Therefore, a policy and academic debate is underway regarding the definition of value in healthcare, the inclusion of costs in value metrics, and the importance of each value element. This study aimed to define healthcare value elements and assess their relative importance (RI) to the public in England.

METHOD

Using data from 26 semi-structured interviews and a literature review, and applying decision-theory axioms, we selected a comprehensive and applicable set of value-based elements. Their RI was determined using two discrete choice experiments (DCEs) based on Bayesian D-efficient DCE designs, with one DCE incorporating healthcare costs expressed as income tax rise. Respondent preferences were analysed using mixed logit models.

RESULTS

Six value elements were identified: additional life-years, health-related quality of life, patient experience, target population size, equity, and cost. The DCE surveys were completed by 402 participants. All utility coefficients had the expected signs and were statistically significant (p < 0.05). Additional life-years (25.3%; 95% confidence interval [CI] 22.5-28.6%) and patient experience (25.2%; 95% CI 21.6-28.9%) received the highest RI, followed by target population size (22.4%; 95% CI 19.1-25.6%) and quality of life (17.6%; 95% CI 15.0-20.3%). Equity had the lowest RI (9.6%; 95% CI 6.4-12.1%), decreasing by 8.8 percentage points with cost inclusion. A similar reduction was observed in the RI of quality of life when cost was included.

CONCLUSION

The public prioritizes value elements not captured by conventional metrics, such as quality-adjusted life-years. Although cost inclusion did not alter the preference ranking, its inclusion in the value metric warrants careful consideration.

Consideration for Health Disparities in Value Assessment Frameworks

Background

Cost-effectiveness analysis (CEA) compares interventions based on relative value and is an integral part of value assessment. Despite recommendations for economists to consider disparities in CEAs that impact health-care resource allocation decisions, the perception held by stakeholders is that value assessment frameworks are inconsistent in practice.

Methods

We reviewed value assessment reports produced by a United States (US)-based value assessment organization to identify how patients and caregiver input may contribute to how the organization considers health disparities. We purposefully extracted and categorized information relevant to health disparities from report sections on Patient and Caregiver Perspectives and Contextual Considerations and Other Potential Benefits to represent the data acknowledged by the organization's patient engagement efforts. We conducted a thematic analysis of the text in these sections and mapped to a health disparities framework endorsed by the National Institute on Minority Health and Health Disparities (NIMHD).

Results

Nineteen evidence reports were included in our analysis. We identified 30 equity-related themes from external stakeholder perspectives or acknowledged in the report and 17 equity-related themes that reflect the actions taken by the economic model developers to address health disparities as a formal part of the CEA. We found examples of the value assessment organization explicitly considering health disparities in cost-effectiveness estimates. However, explicit considerations were not consistent across reports and were not necessarily aligned with patient and caregiver input during model development or consistent with the organization's own contextual considerations.

Conclusion

Our findings highlight the need for a systematic approach for the consideration of health disparities within a value assessment framework and more transparency around how final cost-effectiveness approaches are determined.

Unlocking Continuous Improvement in Heart Failure Remote Monitoring: A Participatory Approach to Unveil Value Dimensions and Performance Indicators

Introduction: Heart failure (HF) constitutes a public health concern affecting quality of life, survival, and costs. Remote patient monitoring (RPM) can enhance HF management, involving patients actively and improving follow-up. While current HF RPM assessments emphasise cost-effectiveness analysis, there is a need to consider wider RPM impacts and integrate stakeholders' perspectives into assessments for better comprehensiveness. Methods: We developed a four-stage participatory approach to select value dimensions and indicators for continuous HF RPM assessment: Stage 1 involved building a literature-informed initial list; Stage 2 utilized expert interviews for validation and list expansion; Stage 3 involved a web-Delphi process with Portuguese stakeholders and experts for agreement assessment; and Stage 4 included a conclusive expert interview. Results: A literature review identified fourteen studies on telehealth, RPM, and HF, informing an initial list of four value dimensions (Access, Clinical aspects, Acceptability, and Costs) and 22 indicators. Seven semistructured interviews validated and further adjusted the list to 38 indicators. Subsequently, the web-Delphi process engaged 29 stakeholders, giving their opinions regarding assessment aspects' relevance and proposing additional elements - 1 dimension and 12 indicators. Five value dimensions and 38 indicators (76.0%) reached group agreement for selection, while 12 did not reach an agreement. Upon expert appreciation, 5 dimensions, 43 indicators, and 6 case-mix parameters were considered relevant. Discussion: This comprehensive social approach captured diverse stakeholder perspectives, achieving agreement on pertinent HF RPM monitoring and evaluation indicators. Findings can inform visualization and management tool development, aiding day-to-day RPM evaluation and identification of improvement opportunities.

Drug pricing and transparency in Europe and the United States: what is it and how does it work?

INTRODUCTION

As drug prices are viewed to be opaque, there have been increasing societal demands on policy and decision makers to implement initiatives that promote drug price transparency.

AREAS COVERED

This Perspective discusses what drug price transparency is and how it works in theory and in practice.

EXPERT OPINION

Transparency on drug prices may target payers, patients and health care professionals; and may relate to prices at each stage in a drug's distribution system. Although proponents claim that drug price transparency will reduce prices and increase patient access, others expect the opposite effect. Nevertheless, a number of international organizations, countries and consumer groups have taken steps to enhance drug price transparency. This has occurred despite a lack of theoretical clarity and of evidence about its likely impact. Policy and decision makers need to consider how payers and pharmaceutical companies are likely to react to drug price transparency and need to be aware that transparency may produce different effects depending on the country to which it is applied. Even though we believe that full drug price transparency is elusive, various incremental measures can be taken to move toward it.

A Research Framework to Improve Health Disparity Evidence Gaps in Value Assessments

A value assessment is intended as a tool for evaluating healthcare treatments to gauge value and inform decisions. Economic value assessments typically incorporate a cost-effectiveness analysis, focusing on costs and health outcomes important to payers, missing important information to ensure existing markets optimize resource allocation. Despite frequent calls for more explicit consideration of health equity impacts in value assessments, health economists continue to develop models informed by traditional cost and quality-of-life data that do not capture differences experienced by health disparity populations. This conceptual paper proposes a research framework to enhance data collection and analysis to address these gaps and better quantify the value of a health innovation, and better assess how a new intervention impacts health disparities. The framework comprises three distinct phases that build on one another: (1) contextualization of lived experiences for disadvantaged communities; (2) individual-level quantification of health disparities for cost and quality-of-life measures; and (3) quantifying community-level impacts.

Scoring the Value Assessment Framework for China: A Factorial Survey

OBJECTIVES

This study aimed to develop the scoring functions for the recently developed value assessment framework (VAF) for China, which comprises 12 attributes.

METHODS

We implemented a factorial survey among Chinese healthcare stakeholders from July to September 2022. A total of 240 hypothetical drug value profiles described by the VAF were grouped into 60 blocks and randomly assigned to respondents. Each respondent was assigned with 1 block, each presented in 3 disease scenarios of different levels of severity. For each profile, respondents were asked to assess the drug's value on a scale from 0 (lowest) to 10 (highest) and make 1 of the 3 insurance recommendations: cover, to be negotiated for coverage, or reject. Linear and logistic mixed-effects models were used to develop scoring functions for aggregating the value attributes.

RESULTS

A total of 365 respondents participated in the survey. 3968 responses from 331 respondents were included in the analysis. Most of the included respondents were under 45 (n = 256, 77.3%), females (n = 208, 62.8%), living in urban areas (n = 296, 89.4%), and with a bachelor's degree or higher (n = 303, 91.5%). Health benefits and safety carried more weights than other attributes in the scoring functions across disease scenarios. The value and probability of entering negotiation or receiving insurance coverage for the attribute profiles for severe/critical disease were higher than for mild/moderate disease.

CONCLUSIONS

The scoring functions of the VAF can be used to assess the value of a drug and its probability of entering negotiation or receiving insurance coverage in China.

The role of open innovation in addressing resource constraints in healthcare: a systematic literature review

PURPOSE

The resource crisis in healthcare can be alleviated by engaging external stakeholders and resources in healthcare delivery. The authors use value and open innovation concepts to understand what motivates the stakeholders to join the healthcare innovation ecosystem and what value such an ecosystem brings to healthcare.

DESIGN/METHODOLOGY/APPROACH

A systematic literature review following the PRISMA framework method was applied to reach the research objective. Out of a total of 509 identified articles published till 2021, 25 were selected as relevant for this review.

FINDINGS

Six categories of actors were identified, including innovation intermediaries, which were so far neglected in the healthcare innovation literature. Furthermore, patients, healthcare providers, innovation suppliers, investors and influencers were described. The authors also distinguished internal and external stakeholders. The authors show why and how open innovation projects contribute to involving external stakeholders and resources in healthcare delivery by contributing to patient autonomy, relationship building, knowledge transfer, improving collaborative mindset and culture, advancing know-how and bringing additional finances.

ORIGINALITY/VALUE

This article is the first one to systematically describe the value of open innovation in healthcare. The authors challenge the positivist approach in value presented by value-based healthcare. The authors show how openness contributes to addressing the resource crisis by involving new stakeholders and resources in the care delivery process.

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

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.

Which value aspects are relevant for the evaluation of medical devices? Exploring stakeholders' views through a Web-Delphi process

BACKGROUND

Implementation and uptake of health technology assessment for evaluating medical devices require including aspects that different stakeholders consider relevant, beyond cost and effectiveness. However, the involvement of stakeholders in sharing their views still needs to be improved.

OBJECTIVE

This article explores the relevance of distinct value aspects for evaluating different types of medical devices according to stakeholders' views.

METHODS

Thirty-four value aspects collected through literature review and expert validation were the input for a 2-round Web-Delphi process. In the Web-Delphi, a panel of participants from five stakeholders' groups (healthcare professionals, buyers and policymakers, academics, industry, and patients and citizens) judged the relevance of each aspect, by assigning a relevance-level ('Critical', 'Fundamental', 'Complementary', or 'Irrelevant'), for two types of medical devices separately: 'Implantable' and 'In vitro tests based on biomarkers'. Opinions were analysed at the panel and group level, and similarities across devices were identified.

RESULTS

One hundred thirty-four participants completed the process. No aspects were considered 'Irrelevant', neither for the panel nor for stakeholder groups, in both types of devices. The panel considered effectiveness and safety-related aspects 'Critical' (e.g., 'Adverse events for the patient'), and costs-related aspects 'Fundamental' (e.g., 'Cost of the medical device'). Several additional aspects not included in existing frameworks' literature, e.g., related to environmental impact and devices' usage by the healthcare professional, were deemed as relevant by the panel. A moderate to substantial agreement across and within groups was observed.

CONCLUSION

Different stakeholders agree on the relevance of including multiple aspects in medical devices' evaluation. This study produces key information to inform the development of frameworks for valuing medical devices, and to guide evidence collection.

Introducing value-based healthcare perspectives into hospital performance assessment: A scoping review

OBJECTIVE

Value-based healthcare (VBHC) puts patient outcomes at the center of the healthcare process while optimizing the use of hospital resources across multiple stakeholders. This scoping review was conducted to summarize how VBHC had been represented in theory and in practice, how it had been applied to assess hospital performance, and how well it had been ultimately implemented.

METHODS

For this review, we followed the PRISMA-ScR protocol and searched five major online databases for articles published between January 2006 and July 2022. We included original articles that used the concept of VBHC to conduct performance assessments of healthcare organizations. We extracted and analyzed key concepts and information on the dimensions of VBHC, specific strategies and methods for using VBHC in performance assessment, and the effectiveness of the assessment.

RESULTS

We identified 48 eligible studies from 7866 articles. Nineteen nonempirical studies focused on the development of a VBHC performance assessment indicator system, and 29 empirical studies reported on the ways and points of introducing VBHC into performance assessment and its effectiveness. Ultimately, we summarized the key dimensions, processes, and effects of performance assessment after introducing VBHC.

CONCLUSION

Current healthcare performance assessment has begun to focus on implementing VBHC as an integrated strategy, and future work should further clarify the reliability of metrics and their association with evaluation outcomes and consider the effective integration of clinical outcomes and patient-reported outcomes.

Identifying Attributes for a Value Assessment Framework in China: A Qualitative Study

BACKGROUND

Value assessment frameworks (VAFs) are promising tools for measuring the value of health technologies and informing coverage policymaking; however, most published VAFs were developed for high-income countries. This study aimed to identify value attributes as part of the development of a VAF in China.

METHODS

We used the qualitative description approach. Specifically, we conducted open-ended semi-structured interviews with Chinese stakeholders, as well as a review and analysis of publicly available government documents related to health technology assessment (HTA) and coverage policies in China. Conventional content analysis and the constant comparison technique were used to generate value attributes. Multiple criteria were used to determine the inclusion of a value attribute, with response levels of included attributes finalized via consensus meetings among the research team.

RESULTS

Thirty-four stakeholders living or working in China completed the semi-structured interview. These stakeholders included policymakers (n = 4), healthcare providers (n = 8), HTA researchers (n = 6), patients and members of the general public (n = 9), and industry representatives (n = 7). In addition, 16 government documents were included for analysis. Twelve value attributes grouped in eight categories are included in the VAF: (1) severity of disease; (2) health benefit, including survival, clinical outcomes, and patient-reported outcomes; (3) safety; (4) economic impact, including budget impact to payer and patients, and cost effectiveness; (5) innovation; (6) organizational impact; (7) health equity; and (8) quality of evidence.

CONCLUSION

These 12 value attributes were identified for the development of a VAF to support health technologies' value assessment and coverage policymaking in China.

The Value of New: Consideration of Product Novelty in Health Technology Assessments of Pharmaceuticals

BACKGROUND

Efforts to understand how treatments affect patients and society have broadened the criteria that health technology assessment (HTA) organizations apply to value assessments. We examined whether HTA agencies in eight countries consider treatment novelty in methods and deliberations.

METHODS

We defined a novel pharmaceutical product to be one that offers a new approach to treatment (e.g., new mechanism of action), addresses an unmet need (e.g., targets a rare condition without effective treatments), or has a broader impact beyond what is typically measured in an HTA. We reviewed peer-reviewed publications and technical guidance materials from HTA organizations in Australia, Canada, England, France, The Netherlands, Norway, Sweden, and the United States (US). In addition, we explored how HTA organizations integrated novelty considerations into deliberations and recommendations related to two newer therapies-voretigene neparvovec for an inherited retinal disorder and ocrelizumab for multiple sclerosis.

RESULTS

None of the HTA organizations acknowledge treatment novelty as an explicit value criterion in their assessments of pharmaceutical products. However, drugs that have novel characteristics are given special consideration, particularly when they address an unmet need. Several organizations document a willingness to expend more resources and accept greater evidence uncertainty for such treatments. Qualitative deliberations about the additional unquantified potential benefits of treatment may also influence HTA recommendations.

CONCLUSION

Major HTA organizations do not recognize novelty as an explicit value criterion, although drugs with novel characteristics may receive special consideration. There is an opportunity for organizations to codify their approach to evaluating novelty in value assessment.