Given their ever-growing visibility, US value assessment initiatives warrant close attention. Therefore, the commentary by DuBois et al1 is to be welcomed. The piece raises a number of valuable points; above all that each value framework offered to date has strengths and limitations, and all have opportunities for improvement.
The authors usefully enumerate a set of key principles that they believe should underlie every framework. These principles are reasonable, and in the main, not terribly controversial. Most would agree that frameworks should be transparent and reproducible; that evaluations of interventions should be revisited over time; that there is merit in taking a broad perspective; that assessments should incorporate elements important to patients; and that a diversity of approaches reflecting the needs of diverse stakeholders should be considered. Finally, the article aptly raises various concerns (eg, about the lack of transparency, the absence of a societal perspective, and the need for more attention to patient preferences) with some of the existing frameworks. Arguments such as these should encourage the field to improve its methods and help the larger medical and policy communities find common ground about what constitutes value.
Peter J. Neumann