ISSUE: Evidence indicates public preference to prioritise health gains for severe health problems. The panel will debate how to operationalise this. Should it be an automatic adjustment or one contextual factor for deliberation? Do we have an agreed, measurable definition of severity that enables us to do this? How do we address opportunity cost? Perspectives will come from a leading HTA body, an academic working on severity, and a patient advocate representing severe diseases with other key attributes that matter.

OVERVIEW: The panelists perspective will be as follows:

Adrian Towse will moderate the session and set out the approaches being taken by different HTA bodies and alternative measures of severity in the literature. He will note a trend to incorporating severity adjustments directly into thresholds.

Steve Pearson (ICER) will provide an HTA approach, arguing that severity is relevant to value but that ICER’s current “contextual consideration” is appropriate, given disagreement over the most appropriate conceptualization of severity, the importance of other factors that impact value, and of the opportunity cost for health systems of higher prices.

Chuck Phelps will provide an academic perspective, arguing severity can be operationalised in continuous manner, as described in the GRACE framework. A continuous approach provides transparency and consistency.

Durhane Wong-Rieger will provide a patient perspective, arguing that “severity” should be at least ONE modifier but that begs the question of how to measure severity across conditions in a way that is acceptable. A highly contextualized approach is necessary if no one solution that fits all diseases, treatments, and payer scenarios.

Following a brief introduction to the issue by the moderator (4 mins), each panellist will speak for 12 minutes and we will allow 20 minutes for audience interaction.