OBJECTIVES: To describe a framework for the integration of encompassing models of value into health technology assessment (HTA) decision processes, and to use this to work through the implications of implementing broader models of value, using an ‘end-of-life premium’ as an exemplar proposition. METHODS: Building on a scoping review of the literature on the role of values in HTA and the use of cost-effectiveness thresholds for reimbursement decisions, we describe a model for ensuring that opportunity cost is appropriately captured in the willingness-to-pay value. We then show how the modified model would impact upon coverage decisions which include an ‘end-of-life premium’. RESULTS: We identify four broad categories of value premia. We characterise the importance of locating opportunity cost factors (including price and budget impact) outside the value framework. We then describe a structural process for ensuring that the value framework is applied equally to the identified beneficiaries of a technology and the frequently unidentified individuals who will bear the opportunity cost, in order to promote horizontal equity in HTA processes. Finally, we show how the conventional approach to incorporating value premia, such as the ‘end-of-life premium’, promotes inefficient and inequitable resource allocation decisions. CONCLUSIONS: The conventional HTA model does not adequately reflect the social value of health care. However, naïve modifications to the cost-effectiveness threshold lead to both inefficient and inequitable resource allocation decisions. It is important that modified value frameworks are applied equally to the identified beneficiaries of a technology and those individuals who bear the opportunity cost.