ISSUE: Cost-effectiveness analysis (CEA) provides a rigorous framework for measuring value and assessing tradeoffs to facilitate decision-making across alternatives. Nevertheless, policymakers often adapt CEA frameworks to suit their own contextual priorities. For example, the United Kingdom (UK) makes reimbursement decisions based upon cost-effectiveness thresholds, but it allows for higher thresholds in certain contexts, such as end-of-life care. Some decision-making bodies have begun to use alternative approaches to health technology assessment, such as multiple-criteria decision analysis (MCDA), which explicitly considers the individual criteria that may be relevant in evaluating tradeoffs within a particular context. There is a need to explore the lessons learned from different approaches to value assessment that have been implemented globally to understand the most viable solutions to account for societal priorities in systematic way. These issues need to be examined from a methodological perspective and from the standpoint of tractability to policymakers.

OVERVIEW: This panel will debate the merits of alternative approaches to account for societal priorities in health technology value assessments. Peter Neumann will summarize the different approaches for value assessment globally in the context of current policy trends. He will also frame the key pros and cons of established approaches. Can CEA account for the nuances of societal priorities? Can MCDA appropriately aggregate values in a standardized and consistent manner? Finn Kristensen will represent a European academic perspective, taking the stance that elements of both CEA and MCDA should be incorporated into future value assessments. Mark Sculpher will reflect on his experience in UK HTA and will argue that CEA can be expanded to reflect other aspects of social value but this has to be undertaken appropriately. Devin Incerti will represent a US methodological perspective and will argue for increased use of MCDA, speaking to recent progress in applications of MCDA.