Presentation (CTI)

OBJECTIVES: With rising healthcare costs, patient access to novel treatments can be restricted due to payer-related budget constraints and an underrecognized perception of value of medicine. In the absence of a formal technology assessment process in the US, there is renewed pressure on pricing systems, where value assessment frameworks are considered. However, they lack consistency, perspective and transparency. With ongoing debates around value and affordability of new interventions, the use of cost-effectiveness analyses (CEA) to support decision-making has increased. However, traditional CEA does not fully reflect the value added by new interventions, resulting in the need for a broader approach. This research aims to develop a framework mapping GCEA value elements to payer archetypes. This will support decision-making and pricing reforms.
METHODS: A targeted literature review was conducted to identify value assessments used by US payer archetypes and assess how GCEA value elements apply to each archetype to further inform decision making.
RESULTS: Of 1,013 references identified, 57 were extracted. Payers prioritize equity and adherence value elements (identified in n=17 and n=13 publications, respectively), although definitions vary. Other important elements include disease risk reduction (n=5) for preventative treatments, value of knowing (n=4) and patient-centred health improvement (n=4).
CONCLUSIONS: Publications demonstrated that to determine the relevance and prioritization of the value elements, it is important to assess three key factors: 1) the organization’s affinity to risk 2) key product challenges 3) the availability of tools for implementing and determining relevant GCEA value elements. A framework centred around risk, challenges, and available tools can therefore inform decision-making. While payers acknowledge equity, adherence and disease risk reduction, other GCEA value elements are underrepresented in the literature. Addressing these elements as part of a framework could guide payers in decision making to improve access to innovative treatments.