Session (CTI)

Issue: At the center of health technology assessment (HTA) lies the question of whose preferences should drive decisions about health technology adoption. Should value assessment reflect the preferences of patients, premium- and tax-paying consumers, regulators, third-party payers, healthcare providers or some combination of these stakeholders? This question arises in a number of timely and difficult resource-allocation decisions, like how to manage soaring patient demand for anti-obesity medicines. It also underlies debates over whether to use so-called “novel” elements of value from the ISPOR “value flower,” the salience of patient-centered economic theories like Generalized Risk-Adjusted Cost-Effectiveness (GRACE), proper approaches for measuring health-related quality of life and equity, and the role of risk preferences in value assessment. Focusing on the preferences of patients and consumers supports the adoption of novel value elements and the incorporation of risk preferences into value assessment. In contrast, aligning HTA with the preferences of payers or regulators, or a notion of aggregate societal preferences, supports QALY-based decision making. Overview: Goodman will introduce the debate over whose preferences matter most, and its implications for a variety of current debates over the ISPOR value flower, QALYs, GRACE, and other methodological questions (5 minutes). Lakdawalla will present the case for incorporating individual-level risk preferences into value assessment and argue why such approaches may better align with welfare economics and decision-making (10 minutes). Briggs will argue that healthcare decision making should be anchored in aggregate societal preferences, while critically examining where, and under what conditions, departures from this approach may be justified (10 minutes). Whittington will provide an inclusive perspective, outlining strengths and weaknesses of both approaches, and practical solutions for the consideration within HTA (10 minutes). The panel will then “negotiate” a preference realignment for technology adoption, followed by questions and critique from the audience (25 minutes).