THE VALUE VOCABULARY: AN ANALYSIS OF SOCIETAL TERMS IN CDA-AMC AND INESSS HEALTH TECHNOLOGY ASSESSMENT DECISION MAKING
Author(s)
Jessica Moreira, MBiotech, BHSc1, Lori Yin, MBiotech, MSc1, Simon Yunger, MBA, BA1, Jean-Eric Tarride, PhD, MA2;
1Hoffmann-La Roche Limited, Mississauga, ON, Canada, 2McMaster University, Hamilton, ON, Canada
1Hoffmann-La Roche Limited, Mississauga, ON, Canada, 2McMaster University, Hamilton, ON, Canada
OBJECTIVES: This study examines the impact of the CDA-AMC’s new Deliberative Framework (DF), implemented in October 2025—one aspect of which allows manufacturers to include a societal perspective, alongside the payer perspective, for complex reviews as part of a societal perspective pilot.
METHODS: A comparative analysis was conducted on CDA-AMC recommendations (n=114) issued one year prior (n=103) and post-DF implementation (n=11, as of December 1, 2025), using manual review and NotebookLM-generated summaries. Reports were evaluated for frequency and context of societal keywords (e.g., productivity, caregiver burden, travel costs). Complex submissions explicitly incorporating societal perspective economic analyses (7/114) were further analyzed, and the corresponding INESSS reviews (n=5/7) were analyzed to compare across HTA bodies.
RESULTS: Post-DF recommendations (n=11) show a shift toward acknowledging nonclinical needs as a formal value domain. Before DF, concepts such as caregiver burden (22 mentions) and travel costs (15 mentions) were primarily found in patient input. Following DF, these factors were more explicitly linked to clinical conditions (e.g., home-based administration reducing out-of-pocket costs), rather than pricing or funding recommendations. For the seven post-DF submissions with societal perspective evaluations, 57% of CDA-AMC base case reanalyses did not consider the societal perspective. Among the three CDA-AMC reanalyses considering the societal perspective, committee deliberations reviewed the societal perspective evaluations but found them too uncertain for decision-making, resulting in continued prioritization of the payer perspective. INESSS reports (n=5) indicated stronger emphasis on societal values (e.g., family spillover, 30+ mentions) but found marginal practical impact on outcomes, with 80% of the drugs ultimately receiving negative recommendations.
CONCLUSIONS: The CDA-AMC initiatives have transitioned the integration of societal values from informal stakeholder input to a structured deliberative pillar. Though early and limited in sample size, our findings suggest the practical impact of societal value centers on nonclinical needs and shaping reimbursement conditions, rather than influencing deliberations via economic evaluations.
METHODS: A comparative analysis was conducted on CDA-AMC recommendations (n=114) issued one year prior (n=103) and post-DF implementation (n=11, as of December 1, 2025), using manual review and NotebookLM-generated summaries. Reports were evaluated for frequency and context of societal keywords (e.g., productivity, caregiver burden, travel costs). Complex submissions explicitly incorporating societal perspective economic analyses (7/114) were further analyzed, and the corresponding INESSS reviews (n=5/7) were analyzed to compare across HTA bodies.
RESULTS: Post-DF recommendations (n=11) show a shift toward acknowledging nonclinical needs as a formal value domain. Before DF, concepts such as caregiver burden (22 mentions) and travel costs (15 mentions) were primarily found in patient input. Following DF, these factors were more explicitly linked to clinical conditions (e.g., home-based administration reducing out-of-pocket costs), rather than pricing or funding recommendations. For the seven post-DF submissions with societal perspective evaluations, 57% of CDA-AMC base case reanalyses did not consider the societal perspective. Among the three CDA-AMC reanalyses considering the societal perspective, committee deliberations reviewed the societal perspective evaluations but found them too uncertain for decision-making, resulting in continued prioritization of the payer perspective. INESSS reports (n=5) indicated stronger emphasis on societal values (e.g., family spillover, 30+ mentions) but found marginal practical impact on outcomes, with 80% of the drugs ultimately receiving negative recommendations.
CONCLUSIONS: The CDA-AMC initiatives have transitioned the integration of societal values from informal stakeholder input to a structured deliberative pillar. Though early and limited in sample size, our findings suggest the practical impact of societal value centers on nonclinical needs and shaping reimbursement conditions, rather than influencing deliberations via economic evaluations.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
HTA54
Topic
Health Technology Assessment
Topic Subcategory
Decision & Deliberative Processes, Systems & Structure, Value Frameworks & Dossier Format
Disease
No Additional Disease & Conditions/Specialized Treatment Areas