Accounting for Stakeholder Preferences in Value Assessments

Stakeholder preferences matter when it comes to value assessment, but only if the right questions are being asked.

In a panel discussion at the ISPOR 22nd Annual International Meeting, held May 20-24 in Boston, Massachusetts, Ilene Hollin, PhD, MPH, of the National Pharmaceutical Council, discussed differences in how stakeholders prioritize value inputs; Eleanor Perfetto, PhD, RPh, MS, of the National Health Council, highlighted ways to incorporate patient inputs into decision-making frameworks; and Michael S. Sherman, MD, MBA, MS, of Harvard Pilgrim Health Care, discussed the payers perspective of incorporating patient-centered inputs into decision making.

"Different stakeholder groups view value in different ways," Hollin said in an interview with The American Journal of Managed Care^®. "Patients, for instance, when they think about value, they’re thinking about, 'How does this therapy help me achieve my life objectives?' Payers, on the other hand, are thinking about value and then designing coverage policies accordingly in terms of how to give patients access to the therapies that meet those life objectives."

One of the biggest issues is the lack of useful data. According to Perfetto, there is no data on what is most important to patients. In addition, there has been a focus on very clinical endpoints instead of the kind of goals that patients are most interested in.

“If we don’t have information from patients on what’s most important to them, and even if we did find out what is most important to them, we don’t know which treatments can meet that need,” Perfetto said.

Sherman prefaced his presentation by saying that among the discussions about pricing and access, it’s important to remember that the stakeholders—insurers, pharmaceutical companies, providers, etc—are there to treat patients.

He provided the example that at Harvard Pilgrim there are value-based agreements for orthopedics, but the outcome measures tend to be high level—satisfaction, readmission, etc—but the things that are most important, such as range of motion or pain, are not usually part of the agreements because they are hard to collect as measures.

“Which is a lousy excuse, but we have lot of work to do in other areas, which is my point,” he said.

Harvard Pilgrim has embraced a number of value frameworks, but having used them, there are 2 main issues: they only cover a small number of drugs and they’re not all actionable. Unfortunately, Sherman isn’t sure if the second issue will change.

“Frameworks are helpful, but it doesn’t always lead to something that is actionable for a payer,” he said. Also, these frameworks are not necessarily patient-centered. The area is ripe for innovation, he added.

Hollin explained that stakeholder preferences, particularly patient preferences can be better incorporated into value assessments by thinking about it earlier in the development stages of the framework. This involves ensuring that the developer is looking at the right clinical endpoints that matter to patients and that what is being measured is important to them.

“Once we have those types of preferences they can be better incorporated into value assessments,” Hollin said. This provides the ability to offer a range that accounts for a variety of preferences.

Perfetto added that current frameworks rely heavily on randomized controlled trial data, and that should not be the case.

“We’re letting the data drive the model and it may be that it’s the wrong input that we started with in the first place,” she said.