Session (CTI)

Separate registration required.

This short course will focus on the ongoing evolution of US value assessment frameworks. We trace this by beginning with the highly cited ISPOR Special Task Force Report (2018), “A Health Economics Approach to US Value Frameworks.” We will provide an overview of recent US value assessment frameworks from the ISPOR Value Flower, through to Generalized and Risk-Adjusted Cost-Effectiveness (GRACE) valuation methodology, and on to Generalized CEA (GCEA), introducing new concepts involving “stacked cohorts” of beneficiaries and the consequences of patent expiry. We also emphasize the importance of perspective and decision context in the construction and use of value frameworks. We will discuss how a health economics approach from a societal or health plan perspective leads to the use of GCEA to help guide efficient resource allocation.

The course will provide in-depth discussion of how measuring some aspects of the value of health benefits could augment the standard cost-per-quality-adjusted-life-year metric for CEA. Elements such as value of insurance, value of “hope,” real option value, severity of illness, and several others, have the potential to better capture how patients and/or society value the benefits of some treatments. Each one is based on some research findings, and some case examples will be shown.

The course will then review how budget considerations, cost-effectiveness thresholds, and opportunity costs enter CEA-based decision-making. Next, faculty will also review broader approaches to cost-benefit aggregation and value-based decision-making, including augmented CEA (introduced by the ISPOR Task Force Report), GCEA, and multi-criteria decision analysis (MCDA), with an overview of issues and new approaches to MCDA. The discussion will incorporate new approaches that combine various CEA frameworks with formal social welfare functions (SWFs), focusing on those that respect individuals’ own evaluations of their well-being and the Pareto principle.