Now Is the Time for Transparency in Value-Based Healthcare Decision Modeling


In contrast to many other countries, during the 20 years since the founding of Value in Health, the United States has moved further away from using value-based healthcare decision modeling (VHDM) for drugs and other medical care choices. US public and private health plans can be typically characterized as using “budget impact” decision making rather than VHDM, with drugs having low per-member per-month spending likely to be covered and reimbursed regardless of value. Orphan drugs and specialty drugs with relatively few patients (eg, end-stage cancer drugs) are often covered, whether cost-effective or not, because health plans want to avoid negative publicity. Although there are many explanations for the poor US uptake of VHDM, a key reason is that VHDM models and data often lack transparency and are not generally made available to researchers for independent verification and reproducibility. This violates the scientific method, and is counter to the stated position of the National Academy of Sciences and the top journals in the sciences and social sciences. Value in Health and related peer-reviewed journals could make a key contribution to improving scientific rigor and real-world healthcare decision-maker acceptability by requiring that VHDM models, source code, and data used in published articles be made freely available to interested readers.


Joel W. Hay

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