NPC Provides Guiding Practices for Creating Value Frameworks

Since the first value frameworks were made public a few years ago, there has been a further proliferation of these assessments. However, while they were well-intentioned in their creation, they all have their flaws along with their strengths, according to Dan Leonard, MA, president of the National Pharmaceutical Council (NPC). As a result, NPC has created a set of guiding practices that relate to value determination and budget impact assessment.

The purpose of the guiding practices is to provide a specific elements that should be included in a value assessment if a company or organization is considering creating one of these frameworks from scratch.

“Our goal is not to stop value determinations,” said Robert Dubois, MD, PhD, chief science officer and executive vice president of NPC. “Our goal is to say, ‘Assessing value is a critical piece of how we move forward in healthcare, and these value frameworks are very valuable as part of the dialogue, but they have to be done right or you may limit access for patients to therapies that for those patients who are very, very valuable.’”

NPC also released a white paper comparing 5 existing frameworks:

• The American College of Cardiology and the American Heart Association Statement on Cost/Value Methodology in Clinical Practice Guidelines and Performance Measures
• The American Society of Clinical Oncology’s Conceptual Framework to Assess the Value of Cancer Treatment Options
• The Institute for Clinical and Economic Review Value Framework
• Memorial Sloan Kettering Cancer Center’s DrugAbacus
• The National Comprehensive Cancer Network’s Evidence Blocks

Where Value Assessment Frameworks Are Lacking

Ultimately, NPC determined that the patient voice was not carried throughout these frameworks, explained Leonard. However, the patient’s perspective or assessment of what is important should be included in every value framework, even if patients are not the end user. Kimberly Westrich, MA, vice president of Health Services Research, added that she was surprised there was not more of a focus in the frameworks they analyzed on what is important to the patient.

“Payers typically looking at a 1-year period and what is the impact going to be the impact on the next year, whereas the patient is interested on their whole life,” she said. “And thinking about not only all of the things that are not only important to the patient, but what is going to happen to them on a longer time period than just 1 year is important.”

Another area where current frameworks are lacking is taking a system-wide view. Only 2 of the 5 frameworks analyzed can be applied to other areas of healthcare outside of drugs. But, most of the frameworks do focus on applying assessments to drugs, which is part of the current public dialogue and concern around drug costs, explained Dr Dubois. The NPC guiding practices include the necessity of applying value assessment frameworks to all aspects of healthcare.

“If there are low-value drugs, which there may be some uses that are low value, even if you eliminated all of that, you’re not going to save a whole lot of money, because drugs are only 15% of the healthcare spend,” explained Dr Dubois. Reducing that spend by 10%, really only saves about 1% overall. “Whereas if you dealt with hospital aspects which are perhaps low-value, and you similarly reduced it by 10%, you get a lot more potential savings.”

Future of Value Assessment Frameworks

NPC expects more value assessment frameworks to be created, by payers, by provider groups, perhaps even by region, as these groups will all have different ideas of what constitutes “value.” The alternative might be to evolve value assessment to a one-size fits all model, like the United Kingdom has. However, Dr Dubois doesn’t not believe that approach makes sense for the US.

A one-size fits all approach requires everyone to agree on what value is and the country is not moving in that direction. Instead, Dr Dubois looked to the Memorial Sloan Kettering DrugAbacus, which allows anyone to input their own preferences and views into value determination.

“There is no one answer to value or value assessment, so there’s certainly room, and there should be, for multiple value assessment frameworks that are done according to guiding practices. If you look at what’s out there right now there are several related to oncology,” Westrich said, later adding, “There is room for well-done value assessment in many areas and, potentially, a need for it.”

However, Dr Dubois admitted that having multiple value frameworks in oncology will be confusing. Perhaps, he suggested, one of them may gain the greatest recognition. Or perhaps the US could, similar to the UK, agree one one value framework, but that has elements of DrugAbacus and lets people add their own preferences to weight the elements.

That may be a long way off in the future, though.

“Our healthcare system is multi-stakeholder, multi-dimensional, multi-payer, multi-faceted,” Leonard said. “It would be hard for me to envision a single value framework. But it’s very early.

To view the guiding practices, click here.