Presentation (CTI)

OBJECTIVES: This study develops a context-specific value assessment approach for Kazakhstan that captures dimensions of value not reflected in conventional cost-per-QALY analysis. In a setting characterised by marked regional disparities and high out-of-pocket spending of approximately 30%, reliance on incremental cost-effectiveness ratios alone risks overlooking societal priorities such as financial protection and fairness. Building on the ISPOR Value Flower, we adapt its concepts to support the practical application of multi-criteria decision analysis for national reimbursement decisions.
METHODS: The framework was developed through a structured deliberative process involving a technical working group comprising policymakers, clinicians, and patient representatives. A modified Delphi approach was used to identify and weight relevant value attributes derived from the ISPOR Value Flower. The framework was tested using retrospective case studies of high-cost oncology medicines and orphan drugs. Particular attention was given to operationalising value elements that are rarely incorporated into routine HTA, including financial risk protection and equity related to disease severity, informed by generalised risk-adjusted cost-effectiveness.
RESULTS: The resulting value assessment approach preserves core efficiency measures, including clinical benefit and QALYs, while explicitly recognising equity and financial protection as high-priority decision criteria. A severity-based modifier was introduced to give greater weight to health gains in conditions associated with large absolute shortfalls in quality-adjusted life expectancy. In addition, the framework assigns explicit weight to interventions that reduce the risk of catastrophic health expenditure, particularly relevant for rural and lower-income regions such as Turkestan, reflecting the insurance value of publicly funded coverage.
CONCLUSIONS: Moving beyond a single efficiency metric towards a multidimensional value assessment improves the transparency, consistency, and perceived legitimacy of reimbursement decisions in Kazakhstan. Explicit recognition of equity and financial protection helps align technical HTA processes with societal priorities and supports the objectives of the national “Healthy Nation” agenda, strengthening the link between evidence-based decision making and social values.