Researchers from Duke-Margolis and DCRI received two of three grants awarded by the PhRMA Foundation for work impacting the development of new value-based care models in the United States.
Value Assessment Research awardees at Duke include Shelby D. Reed, PhD, of the Duke Clinical Research Institute and Gillian Sanders Schmidler, PhD, of Duke-Margolis. The grants of $100,000 over one year will enable two projects focused on value and cost-effectiveness in health care.
Dr. Reed's project, Quantifying the Value of Hope in Cancer Care, is built on the observation that cancer patients participating in focus groups at the Duke Cancer Institute, conducted to elucidate factors associated with value in cancer care, expressed ‘hope’ as an important feature, often described as living longer and doing things they enjoy. To obtain quantitative measures of the value of hope in cancer care, her project team will design a best-practice discrete-choice experiment (DCE) that will use new ways to display survival periods and probabilities and ask survey participants to choose among treatment options and ask participants to react to a set of opportunity costs. The survey will be administered to 150 adults with a history of cancer and 150 adults without a history of cancer and will help the research team discern the value hope relative to other factors. The project will be carreid out with the PrefER (Preference Evaluation Research) Group at DCRI.
Dr. Sanders Schmidler's project, which includes collaborators Corinna Sorenson, PhD, and Evan Myers, MD, will compare the effect of changing analytic perspectives in decision analytic models on conclusions about the relative value of different strategies across several therapeutic areas by analyzing three previously published cost-effectiveness analyses from four different perspectives: (a) society, (b) overall healthcare sector, (c) individual payer, and (d) patient. Differences between these perspectives include the inclusion or exclusion of out-of-pocket and nonmedical costs, the analytic horizon, and the choice of aggregate outcomes such as quality-adjusted life years (QALYs) or discrete benefits (such as cancer deaths prevented) and harms (such as specific treatment complications or side effects). The three clinical areas are the use of implantable cardioverter-defibrillators (ICD), preoperative testing for malignancy in patients with uterine tumors, and influenza vaccination during pregnancy. By illustrating the impact of changing perspective on value estimation in terms of both traditional economic measures such as cost and quality of life, and in clinical metrics such as the ratio of discrete harms to benefits, this project will provide insight into the utility of incorporating additional perspectives beyond those of society and the healthcare sector into economic analyses, particularly those being done to support value-based care approaches. This insight should prove helpful in design, communication, and dissemination of those approaches by identifying potential conflicts in value conclusions earlier in the process, and by enhancing transparency during dissemination.
Concern over rising U.S. health care costs in recent years has increased interest in promoting high-quality care, while avoiding low value or inefficient care. In response, a number of initiatives aiming to drive value in health care have emerged, but few offer transformative solutions that reflect patient preferences and real-world clinical practice. In addition, many issues in methodology and patient engagement remain unresolved. The PhRMA Foundation launched its Value Assessment Initiative last year to help address these issues.