OBJECTIVES: In 2018, an ISPOR Special Task Force argued that conventional cost-effectiveness analyses (CEAs) often fail to account for a full range of considerations pertinent to an intervention’s benefits and costs. The panel published a “value flower”, with each petal representing either a conventional or so-called “novel” value element. We sought to characterize the inclusion of novel and social value elements in CEAs.

METHODS: We searched the text of CEAs indexed in the Tufts CEA Registry and published from 2016 to 2020 for key words and phrases related to novel and social value elements, such as family spillover, option value, value of hope, and fear of contagion. Following initial screening, we reviewed each article’s full text to determine if the CEAs included novel or social elements in their cost-effectiveness ratio calculations or simply discussed these elements. We then assessed the influence of novel and social elements on cost-effectiveness estimates in the 15 articles that reported ratios calculated both with and without inclusion of these elements.

RESULTS: We identified 30 CEAs, representing about 1 percent of CEAs published from 2016 to 2020, that include at least one novel or social value element in their ratio calculation. In one of six analyses with adding patient time costs moved the ratio from above to below the $100,000-per-QALY benchmark. Including adherence improving factors did so in 4 of 17 cases. Including productivity (n=12), equity (n=6), family spillover (n=8), disease severity (n=4), or real option value (n=1) did not move ratios across the benchmark.

CONCLUSIONS: Given how recently ISPOR published its value flower and how long journals can take to publish papers, it is not surprising to find that few CEAs include novel or societal value elements. Because inclusion of these elements can substantively affect ratio estimates, their omission can diminish the optimality of health resource allocation decisions.