Evolving the Measurement of the Social and Economic Value of Health Technologies

Mark Ferdinand,Vice President, Policy Research and AnalysisRx&D

April 2011CADTH Symposium, Vancouver

Foreword: Values Associated with Health Technology Assessment “Process”

The Value of ‘Values’

Placing an explicit values framework at the forefront of[healthcare] reform will enable the public to holdpolicymakers accountable, so that policies promote and donot detract from underlying values. Without an explicitframework, the expressed goals of health care policy can bechanged indiscriminately. Such a framework can alsofunction as a “yardstick” to evaluate proposals for reform,providing a perspective for analysis and criteria forcomparison.

- Reinhard Preister, “A Values Framework for Health System Reform” , Health Affairs, Spring 1992; 11(1): 84-107, 86.

Organizing Values Across Common Themes for all Health Care Interventions (i.e. services and technologies)

A. Coverage and Demography

1. Who’s covered (Accessibility)?2. What’s covered (Availability – Part I)?3. How is it covered? (Availability – Part II)? 4. When is it covered (Timeliness/Wait Time for Health Technologies)?

B. Outcomes

5. What are the benefits of coverage? (Individual Benefits, Community/Social Benefits, Health System Benefits, and Economic Benefits)

C. Pharmaceutical Management and Pharmaceutical Policy Overview6. How is pharmaceutical care managed? (Affordability/Sustainability)

Measuring Social and Economic Value of Health Technologies

Challenge of Governments of Meeting Demand of New Health Products is Well Documented and Characterized

• “As the costs of public health care have risen, so has the governments’ concern to contain these costs, while at the same time attempting to improve and equalize the standard of health services. […]

• “As well as a policy to place greater emphasis on the prevention and protection from disease and injury, in preference to more intensive treatment of disease, governments are concerned about the cost effectiveness of treatment now being practisedand by the rapidly increasing use of expensive new medical and surgical procedures, diagnostics and support technology” [our emphasis].

• Department of Industry, Trade and Commerce, the Health Care Products Industry: Research and Development in Canada, December 1979, p. 3

Challenge of governments in a nutshell:

Most treatments and preventive measures

add benefits and increase cost

Author’s graphic, inspired by Cohen JT, Neumann

PJ, Weinstein MC, "Perspective—Does Preventive

Care Save Money? Health Economics and the

Presidential Candidates," New England Journal of

Medicine, Vol. 358, No. 7, 2008, p. 3.

75%

4-6%20%

save money

compared to

an alternative

confer benefits

and increase

cost

increase costs

and lead to

worse

outcomes

Do We Need a Complementary Measure to Socially and Economically Evaluate Health Technologies?

• How can we build on existing, accepted means of evaluating the social and economic benefits of medicines

• Can we imagine a broader definition of what is “cost effective”?

• Do community and social considerations belong in an economic assessment?

• How can we take into consideration varying perceptions of ‘value’ in health technology assessment?

Photograph by: Phil Carpenter, THE GAZETTE

ACTORS IN THE DRUG DECISION-MAKING PROCESS AND THEIR QUESTIONS (not exhaustive)

HEALTH CANADA COMMON DRUG REVIEW –CANADIAN EXPERT DRUG ADVISORY PANEL

CADTH

THERAPEUTIC REVIEW PANEL

PATIENTS and HEALTH CARE PROFESSIONALS

PAYORS DRUG SAFETY AND EFFECTIVENESS NETWORK

CLINICAL EFFICACY and SAFETY

Has the intervention proven to be effective

in controlled clinical

trials? Is the new drug, efficacious, safe and of high quality?

How well does a drug relieve symptoms of a specific medical condition in relation to its associated risks?

COST EFFECTIVENESS

Is the intervention efficient?

Is the incremental benefit gained from the new drug worth its incremental cost?

COMPARATIVE CLINICAL EFFECTIVENESS

How does ‘real world’ use of this therapy work in comparison to its clinical efficacy measured by controlled trials?

OR

How well do two or more drugs work in comparison to one another when treating the same condition?

Is the intervention available, safe, affordable?

What care would I like my loved one to receive?

What represents value to me?

Am I free to exercise my clinical judgment?

Do I have access to appropriate resources/evidence to make the best clinical choice?

Which onetherapy works best for a specific medical condition?

Is the care necessary,

meaning is it necessary

to ensure normal

function or to

protect life?

Is it possible to leave

the care up to

individual

responsibility?

COMPARATIVE EFFECTIVENESS

What treatment works best forwhich patient under which circumstances?

This is not as simple as saying A is better than B. e.g. Are there more benefits with new drug compared to competing alternatives or standard care?

Excerpt: CADTH, Guidelines for the Economic Evaluation of Health Technologies: Canada

What we can learn from the world of wellness?

“A Highmark Inc. study published in the March/April edition of the American Journal of Health Promotionfound that health care costs rose at a 15 percent slower rate among wellness participants than a comparison group when employers consistently offered a wellness program to their employees”

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Exp

end

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Forecast Period

Concluding Considerations for Expanding Economic Evaluation to Account for Social Value

• The generation of even more information of new drugs across a wide number of individual researchers, networks and service providers may be of value if the information published allows relevant stakeholders and decision-makers to evaluate this information in their own context (i.e. taking into consideration prevalence of disease in their respective jurisdiction, health care system benefits, willingness to pay, etc.).

• When (in a health technologies’ life cycle) would it be useful for the generation of additional social and economic analyses to complement conclusions drawn from an earlier cost effectiveness analysis (CEA)?