Toward a Broader Concept of Value: Identifying and Defining Elements for an Expanded Cost-Effectiveness Analysis

Area of Science:

• Health economics
• Health technology assessment
• Decision analysis

Background:

• Traditional cost-effectiveness analysis (CEA) relies on the incremental cost-effectiveness ratio (ICER) using quality-adjusted life-years (QALYs).
• This framework, established by Weinstein and Stason (1977), facilitates comparisons across diverse health technologies.
• However, it may not capture the full spectrum of value associated with healthcare interventions.

Purpose of the Study:

• To propose an expanded framework for CEA in health technology assessment.
• To incorporate a broader range of value elements beyond traditional metrics.
• To identify and define new components for a more comprehensive value assessment.

Main Methods:

• Conceptual commentary and framework proposal.
• Identification and definition of additional value drivers.
• Exploration of 'value of knowing' components and informational externalities.

Main Results:

• An expanded framework is proposed, incorporating core value drivers (health gain, cost savings) and additional elements.
• Five factors contributing to the 'value of knowing' are defined: uncertainty reduction, insurance value, value of hope, real option value, and spillovers.
• These elements offer a more nuanced understanding of an intervention's total value.

Conclusions:

• Traditional CEA metrics may underestimate the full value of health technologies.
• Integrating 'value of knowing' and informational externalities can enhance decision-making in health technology assessment.
• Further research is needed to operationalize and measure these expanded value components for practical application in coverage and pricing.