Presentation (CTI)

OBJECTIVES: As HTA increasingly uses RWE for adoption and reassessment, attention shifts from modeled to realized value. However, existing value frameworks emphasize the breadth of value domains, paying less attention to the conditions required for value to emerge. We propose the “stem” of the Value Flower as the contextual system conditions that determines whether value can be realized in real-world practice, and examine how supply-constrained health systems may mask value in RWE.
METHODS: We developed a conceptual framework grounded in HTA, RWE, and supply constraints, distinguishing value domains from the system conditions required for value realization. Using diagnostics as a case, we show how a test that improves referral triage where specialist capacity is constrained may shorten wait times and improve allocation without changing total specialist encounters. The effect may be absorbed by the queue rather than appear in HTA endpoints. The same logic may apply more broadly.
RESULTS: In supply-constrained systems, RWE may fail to show expected downstream changes not because a technology lacks value, but because value is absorbed (e.g., by fixed capacity, queueing, delayed care, or substitution across settings). A technology may improve access or efficiency without producing measurable cost offsets or utilization changes. This creates a tradeoff for RWE-based HTA: treating absence of observed effects as absence of value may undervalue innovations and weaken incentives for technologies whose benefits are hidden by context, while HTA must also avoid allocating scarce resources to modeled gains that cannot be realized in practice.
CONCLUSIONS: Absence of observed effects is not absence of value. RWE-based HTA should consider both the type of value and the conditions under which value can be realized. The proposed contextual dimension highlights the tension between incentivizing innovation and allocating real resources to realizable health outcomes. This identifies an underexplored dimension for future work on system context in RWE-based HTA.