I am just back from beautiful Glasgow where this week you could see Roger Federer play in a kilt and the crème de la crème of healthcare economics gather in the opposite building at another great ISPOR conference. This 20th annual European Congress was about “the evolution of value in Health Care”, and themes ranging from value-based pricing, the future of health technology assessment, and how value is evolving over time were discussed.
Value in healthcare is an evolving concept, which remains difficult to evaluate, despite the growing promotion of more patient-centered approach in health care. Pricing health care products based on their added value first requires to look at how “value” is defined.
And this is no easy task as there is no one universal definition of “value”. The concept of value differs not only between countries but also between stakeholders. A patient will consider value differently compared to a researcher, a manufacturer or a payer.
A value-based approach, as opposed to a cost-effectiveness or efficacy approach, takes into account the effect on patient and population over time. As an example, the value of bringing new antibiotics to the market positively impacts the patient’s life – net value – as well as other individuals who might have been affected if the patient had not been treated – transmission value. However, opinions diverge between manufacturers, researchers and payers when it comes to other types of externalities. And that’s exactly what came out of the workshop “how can we assess the value of new antibiotics?”.
According to Professor Adrian Towse, Director of the Office of Health Economics, traditional HTA looks at the health gain, unmet need, cost offsets and productivity benefits when assessing new antibiotics. But there is more to consider. Other types of benefit could include for example the value of having treatment available as a last resort in case of multi-drug resistant infections, or the fact that antibiotics with novel mechanism of action may avoid problems of cross-resistance. Douglas Lundin, Chief Economist at the Swedish TLV, agreed to consider the net and transmission value as positive externalities when looking at the cost-effectiveness of new antibiotics. However, he insisted on the fact that externalities need to be quantified, and was overall skeptical about other types of externalities.
The least we can say is that antibiotics are like no other products. However they perfectly illustrate how the concept of value differs between stakeholders, and the challenges faced to find a common methodology to assess the value of health technologies.
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