OBJECTIVES: Health technology assessment (HTA) has traditionally relied on cost-effectiveness analysis (CEA) as a cornerstone to evaluate new therapies. The current approach to CEA, however, does not allow for inclusion of more holistic aspects of health; therefore, value elements for new technologies beyond basic clinical and economic value, such as a technology’s impact on patients and society, are largely overlooked. This study aimed to review the recent modelling attempts to expand the traditional CEA approach by incorporating additional elements of value in HTA.

METHODS: A pragmatic literature review was conducted for articles published in English between 2012 and 2022 reporting CEAs including value aspects beyond clinical and cost-effectiveness estimates.

RESULTS: The database search returned 3,456 hits and after duplicates were removed, 13 articles were included in the review. Ten studies were literature reviews offering expert opinion and three were reports from multi-stakeholder workshops or committees. Six articles specifically discussed at least one element considered a beneficial addition to the current HTA value paradigm. Societal values and health equity were the most frequently discussed additional value aspects. Four studies proposed a modification of the current CEA methodology (e.g., distributional CEA, augmented CEA, and extended CEA), nine studies proposed the adoption of multi-criteria decision analysis (MCDA) as an expanded method for future CEAs, and one study used the discrete choice experiment model. Although MCDA was a common recommendation, other approaches familiar to HTA agencies such as augmented CEA were proposed to offer the flexibility to incorporate qualitative aspects of value.

CONCLUSIONS: This review found that several modelling approaches have been tested and proven useful in expanding the current CEA approach to HTA to include additional value elements. Next steps should include moving the discussion from “if” to “how” these additional value elements can inform decision-making and improve patient access to promising technologies.