Nermina Ferizovic | Health Economics Expert

It is commonly argued that the primary aim of healthcare is to achieve value. There are two definitions of value in healthcare which could be applied as part of economic analyses. Firstly, the health policy great, Michael Porter, defined value as “health outcomes achieved per dollar spent” whilst the International Society of Pharmacoeconomics and Outcomes Research (ISPOR) set up a task force to define value in healthcare which led to the generation of a “value flower”. This included the following split: core elements (quality-adjusted life-years (QALYs) and net costs), common elements (productivity, adherence-improving factors, risk of contagion) and novel elements (value of reduction of uncertainty due to a new diagnostic, fear of contagion, insurance value, severity of disease, value of hope, real option value, equity and scientific spillovers). The task force argues that these elements should be considered, context dependent, when assessing health interventions as part of an augmented cost-effectiveness analysis framework. 

Thus, the ISPOR task force breaks down value into several components whilst Porter considers the overall health outcome. The latter could be argued to be patient-centred with its emphasis on health outcomes whilst retaining an element of productive efficiency. Given that health outcomes differ based on context, this approach could also be considered context-dependent but non-prescriptive. On the other hand, the former is explicit in the components of value that should be considered and the context in which they should be applied when conducting a cost-effectiveness analysis. Although, given that the value components are to be applied in a cost-effectiveness framework, where the QALY is prescribed as a “core element” by the task force, this becomes very similar to “health outcomes per dollar spent”. However, Porter does not explicitly recommend the use of his definition in a cost-effectiveness framework, thereby allowing wider applications. 

Thus, some of the key questions to be considered when measuring value of healthcare interventions are the following: 

• Can value of healthcare interventions only be analysed within a cost-effectiveness framework?
• Should explicit value components be applied to economic analyses of healthcare interventions with some degree of context dependence?
• Or should the value components be dependent on the health intervention and the condition being treated?
• Is productive efficiency the overall implicit aim of value in healthcare?