OBJECTIVES: Current health technology appraisal (HTA) practice for intervention value assessment involves estimating cost and health outcomes at an incremental level, often considering the impact of reimbursement from an individual patient and narrow payer perspective, against standard of care. This granular approach may fail to capture the population wide health and budget policy impact of bringing an intervention to market. The Policy, Affordability and Cost-Effectiveness (PACE) model provides an alternative approach to estimating and reporting budget and health outcomes for a new intervention and provides a more comprehensive assessment of value which contextualises the outcomes and facilitates discussion around dynamic policy investment.

METHODS: To explore the PACE modelling framework a case study was developed. The value of Sildenafil was assessed against all comparators in the market as a new intervention in Canadian clinical practice for functional class II pulmonary arterial hypertension. Published discounted cost and quality-adjusted life year (QALY) inputs were used. Market share values were estimated based on the relative proportion of QALY gains.

RESULTS: The reimbursement of Sildenafil, versus all comparator treatments used in clinical practice, would provide 1,585,944 additional QALYs to a population of 14,178,260 in Ontario, at a reduced cost of -$426,507,269,746. Alternatively, per treated patient, the reimbursement of Sildenafil would provide 0.11 additional QALYs at a cost of -$30,082. Results from a pairwise comparison of Sildenafil differ significantly than when all comparators are considered.

CONCLUSIONS: The PACE framework has been developed to explore the broader value of a new treatment across an entire population to inform dynamic investment discussions. By considering all clinically relevant comparators, the framework allows an understand of both affordability and cost-effectiveness. When making healthcare resourcing decisions, it is important to estimate the value new technology based on real world impact, through scenarios reflecting healthcare budget spending and overall population health outcomes.