Developing a System-Centric Framework for Health Technology Value Assessment

OBJECTIVES: Current methods for evaluating healthcare innovations are typically focused on healthcare, despite value being broadly distributed within a larger system. This study aimed to develop a comprehensive system-focussed framework for assessing the value of health system innovations by synthesising current literature and expert opinions.

METHODS: The methodology combined primary and secondary research. To generate the initial framework, a scoping literature review was conducted for articles on value assessment frameworks and health system analysis. The review yielded 1,859 articles, with 21 frameworks extracted after screening. These data informed a skeleton framework with domains and sub-domains to explore in a Delphi exercise. A three-round Delphi was then conducted, engaging 22 experts from academia, industry, patient representation, policy-making, and healthcare regulation. In the first round, participants generated value indicators, or detailed information about characteristics that influence value creation, according to their expertise within the skeleton framework provided. A thematic analysis was conducted using NVivo to consolidate ideas into a complete framework. In subsequent rounds, participants rated the importance of the proposed value indicators on a 5-point Likert scale.

RESULTS: The scoping review identified 44 sub-domains within eight key value domains. The key domains consisted of technology features, politics, health system organisational features, health system governance, health care financing, resource generation, providers and private industry. After consolidation, the Delphi exercise generated 61 value statements from participant proposals in the qualitative first round. After two iterative rounds, 23 statements met the criteria for consensus and stability.

CONCLUSIONS: The value monograph provides a holistic system-centric approach to value assessment by considering diverse stakeholders and the broader health system. This approach addresses gaps in value capture by pinpointing where it is created. It also aligns with the evolving landscape of modern health decision-making. Future research should focus on validating the framework in diverse settings.