PhRMA supports the use of sound evidence to guide health care decisions, and we’re committed to developing tools to help patients, physicians and others make informed decisions.
Value assessments, or health technology assessments, are one tool that can support better value in health care. But current value assessments often fall short of the transparent, patient-centered approach we need. We’re providing support to develop value assessment tools that are open and transparent, rigorous and objective, support doctor-patient decision-making and look at value across the full spectrum of patient care. We’re also working to ensure that value assessments are not misused by government health agencies to impose patient access barriers and delays in care.
Value assessments should include all the outcomes that matter to patients and families, including those in disadvantaged and minority communities. Conventional approaches to value assessment rely on flawed standards such as cost-effectiveness analysis (CEA) and quality-adjusted life years (QALYs) that ignore important elements of value that matter to patients and society. For example, certain treatments provide ALS patients an improved quality of life by protecting their ability to swallow, but QALY-based assessments don’t recognize the value of important improvements like this. Outcomes that matter to patients should matter to everyone.
Value assessments should reduce health disparities and inequities, not reinforce them. Conventional, QALY-based assessments discriminate against vulnerable patient groups, including the elderly, people with disabilities and individuals in disadvantaged or minority populations. According to The American Association of People with Disabilities, “the U.S. established that QALYs discriminate by devaluing disabled lives as far back as 1992.” Unfortunately, we’ve made far too little progress since then in moving beyond QALY-based assessments. Those in lower income communities or in communities of color experience lower life expectancy and greater disease burden, on average, due to underlying health inequities. QALYs discriminate against these patients by assigning a lower numerical value to their life. And health technology assessments rarely account for patient differences, especially those faced in minority populations. According to Tufts Medical Center, fewer than 5% of HTAs include results by race or ethnicity. When insurers and other payers rely on these flawed models to set coverage policy, it can have dire consequences for patients.
Value assessment should span all of health care across the patient journey, not just medicines. Medicines represent just 10% of U.S. health care expenditures, but over 40% of all value assessments. As we look at how to build a more resilient, affordable and equitable health care system, we need to assess value of other aspects of the health care system, too.
Concerns over rising health care costs have led some to call for government price setting for medicines. Some of these flawed ideas include government use of health technology assessments to make important decisions about the value of a treatment and whether patients should have access to an innovative medicine.
We only need to look abroad to see how the story ends when the government makes rigid judgements of clinical benefit to set prices for medicines. For instance, in Germany, just 68% of all new medicines are available. As we move toward a value-driven health care system, we should avoid one-size-fits-all policies that ignore patient differences and equity considerations and create significant access barriers.