The way forward for therapeutics value assessment

Last week’s publication in the Forum for Health Economics and Policy of Valuing the Societal Impact of Medicines and Other Health Technologies: A User Guide to Current Best Practices is a watershed moment for the field of health economics and outcomes research. 

Put simply, we now have a User Guide for implementing generalized cost-effectiveness analysis (GCEA) to more comprehensively capture the societal value of innovative health technologies, written by a dozen leading health economists. The guide should help revolutionize the way we assess the value that new therapeutic treatments generate for patients and society. Built on decades of progress in addressing the limitations of conventional CEA, it shows us a way forward.

Of course there are entrenched interests who may push back against GCEA. Proponents and practitioners of conventional cost-effectiveness analysis may sometimes acknowledge the limitations of their approaches – and might even promise to add in additional elements of value down the road to address these limitations. But in their next breath, they tend to lament a fuzzy inability to more fully measure the value a drug or other medical intervention may generate – for patients, caregivers, or society in general. The methods don’t exist, or they’re not properly vetted. ​“We don’t have the tools,” they’ll say. But the methods in HEOR are never static. They are constantly evolving and need extensive testing and updating.

But in a lot of those cases, we do already have updated tools. This landmark publication of the GCEA User Guide hands HEOR researchers the toolbox – and shows us how and when to use them. How do we account for pricing dynamics, caregiver spillovers, growth of patient populations, equity concerns? It includes the ​“latest and greatest” methods to incorporate each novel value element into a health economics model with illustrative case examples. You can see what many of the paper’s authors have to say about the importance of GCEA and the User Guide itself here. Some have even begun publishing GCEAs using these tools. 

The publication of the User Guide isn’t the end of the conversation or the pinnacle of our understanding of value. Some of these tools can no doubt be improved or made easier to use. Some methods, like incorporating how the price of a drug might change over its lifecycle, are more established and empirically tested. In other cases we might be closer to an abacus than a supercomputer – but even an abacus can help you count past zero and get closer to the truth. 

In any case, no analysis – GCEA, CEA, or otherwise – should be used to set prices for new drugs in a healthcare delivery system like the United States. That’s what the market is for. But GCEA can, more than ever before, show us what a bargain we’re getting from those market forces. 

Next week I’ll be at ISPOR Europe in Barcelona to reconnect with my fellow HEOR practitioners. I look forward to attending the sessions featured in the NPLB recommended program and discussing with my peers how we can better put GCEA methodology into practice and continue to refine our methods (well… preferably over some tapas and a few glasses of sangria).

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Photo by Kait Herzog on Unsplash

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