DEVELOPING AND OPERATIONALIZING A SOCIETAL VALUE FRAMEWORK: A STYLIZED CASE STUDY IN ADVANCED HEPATOCELLULAR CARCINOMA
Author(s)
Meng Li, MS, PhD1, Lu Shi, BA, MPH, PhD1, Joshua Cohen, PhD2, Peter Neumann, ScD2, Amir Tahami, MS, PhD, MD3;
1Tufts Medical Center, The Center for the Evaluation of Value and Risk in Health, Boston, MA, USA, 2Tufts Medical Center, Boston, MA, USA, 3Eisai Inc., Nutley, NJ, USA
1Tufts Medical Center, The Center for the Evaluation of Value and Risk in Health, Boston, MA, USA, 2Tufts Medical Center, Boston, MA, USA, 3Eisai Inc., Nutley, NJ, USA
OBJECTIVES: Efforts to expand value assessment have introduced a range of novel value elements. However, the absence of a coherent conceptual framework and clear operational guidance has limited acceptability and implementation.
METHODS: We developed a unified societal value framework that aggregates the utilities of patients and affected members of their network, defining individual utility as a function of holistic health and consumption and allowing for risk preferences. We then operationalized the framework using a stylized pharmacologic treatment for advanced hepatocellular carcinoma (HCC) under alternative assumptions regarding clinical benefit. Operationalization proceeded in three steps: (1) identifying individuals (connected non-patients) whose health or consumption is materially affected by the patient’s treatment; (2) quantifying impacts on utility for patients and associated individuals; and (3) aggregating individual utilities using the Atkinson index social welfare function. Published quantitative and qualitative evidence informed parameterization where available.
RESULTS: The advanced HCC patient’s close network consisted of one primary caregiver and, in some cases, dependent children. For patients, holistic health included HCC-specific impacts not captured well by EQ-5D-based utilities, such as jaundice, fatigue, nutritional impairment, and sexual functioning. For caregivers, EQ-5D-based measures omitted key caregiving-related impacts, including sleep disruption, relational strain, and fulfillment. Across scenario analyses, accounting for these broader patient and caregiver impacts increased estimated QALY gains by 10-15% under conservative assumptions. Incorporating risk preferences on top of these broader impacts produced only modest additional gains, increasing to 11-16% relative to a conventional QALY-only, risk-neutral approach. Estimated reductions in productivity losses for patients and caregivers ranged US$29,000-$86,000 across scenarios. Treatment is associated with a 0.0008%-0.002% reduction in existing population health inequalities.
CONCLUSIONS: This study demonstrates transparent implementation of a theoretically grounded societal value framework and provides a practical template for future applications while highlighting key drivers of societal value and remaining evidence gaps.
METHODS: We developed a unified societal value framework that aggregates the utilities of patients and affected members of their network, defining individual utility as a function of holistic health and consumption and allowing for risk preferences. We then operationalized the framework using a stylized pharmacologic treatment for advanced hepatocellular carcinoma (HCC) under alternative assumptions regarding clinical benefit. Operationalization proceeded in three steps: (1) identifying individuals (connected non-patients) whose health or consumption is materially affected by the patient’s treatment; (2) quantifying impacts on utility for patients and associated individuals; and (3) aggregating individual utilities using the Atkinson index social welfare function. Published quantitative and qualitative evidence informed parameterization where available.
RESULTS: The advanced HCC patient’s close network consisted of one primary caregiver and, in some cases, dependent children. For patients, holistic health included HCC-specific impacts not captured well by EQ-5D-based utilities, such as jaundice, fatigue, nutritional impairment, and sexual functioning. For caregivers, EQ-5D-based measures omitted key caregiving-related impacts, including sleep disruption, relational strain, and fulfillment. Across scenario analyses, accounting for these broader patient and caregiver impacts increased estimated QALY gains by 10-15% under conservative assumptions. Incorporating risk preferences on top of these broader impacts produced only modest additional gains, increasing to 11-16% relative to a conventional QALY-only, risk-neutral approach. Estimated reductions in productivity losses for patients and caregivers ranged US$29,000-$86,000 across scenarios. Treatment is associated with a 0.0008%-0.002% reduction in existing population health inequalities.
CONCLUSIONS: This study demonstrates transparent implementation of a theoretically grounded societal value framework and provides a practical template for future applications while highlighting key drivers of societal value and remaining evidence gaps.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE368
Topic
Economic Evaluation
Disease
SDC: Oncology