Duke University Team Proposes Principles for Advancing Value Assessment

Determining what treatments provide value commensurate with their costs is an important step in containing healthcare costs and improving outcomes for patients.  At the same time, value assessment frameworks have been criticized for limitations and potential impacts on patients’ access to care.

In an article published in the journal Value in Health, a team from Duke-Margolis, Duke Clinical Research Institute and several external organizations argues that stakeholder input and buy-in are important to ensure the adoption and sustainability of value assessment in the U.S.  The researchers convened a small group of stakeholders representing patient advocacy organizations, drug manufacturers, payers, and academia to discuss factors that hamper uptake or result in misinterpretation.  From these discussions, the team proposed ten guiding principles to improve the next generation of value assessment frameworks, specifically they should:

1. Define and use inclusive and transparent stakeholder engagement processes;
2. Explicitly define their priorities and intended purpose;
3. Include patients’ perspectives;
4. Have a holistic, systemwide scope of work that seeks to evaluate a range of interventions and care practices;
5. Be grounded in established and transparent methods;
6. Capture and apply the full range of available evidence;
7. Address longer term outcomes;
8. Measure and assess relevant costs and cost-effectiveness using sound, vetted methods;
9. Have the ability to adapt to shifts in sciences, evidence, values, and the health care system more broadly;
10. Be developed with feasible implementation strategies reflecting practical opportunities to improve value-based care.

Observing that current debates highlight the need for additional research and multistakeholder dialogue, the team recommends that experts focus on defining and measuring value and understanding differences and commonalities within stakeholder groups, continue to refine and vet principles to ensure that there is stakeholder consensus on how value assessment frameworks should be structured, gain expert consensus on methodological and procedural standards, and seek a road map for implementation.  Once adopted, value assessment frameworks should be evaluated to determine whether they achieve stated aims and meet patient and system needs.

The team was led by Corinna Sorenson of DCRI and Mark McClellan of the Duke-Margolis Center for Health Policy and included Gabriela Lavezzari and Gregory Daniel from Duke-Margolis, Gillian Sanders from DCRI, Edmund Pezalla from Enlightenment Bioconsult, LLC, Marc Boutin from the National Health Council and Randy Burkholder from the Pharmaceutical Research and Manufacturers of America.