The Case For Patient-Centered Assessment Of Value

Value assessments are all the rage these days. From ASCO to ESMO, from MSKCC to AHA/ACC, from AMCP to ICER, there are a variety of value frameworks (and acronyms) out there. In the Health Affairs blog today, Alan Balch and Darius Lakdawalla make the case that treatment value should be measured from a patient-centered approach. Although patient-centered measures of value clearly are sensible–as patients are the end consumers of medical goods and services–there are good reasons why value does not always take the patient’s perspective.

Economics, the science of measuring value, holds that the value of any good rests in the eye of its consumers. In health care, this has meant that value is defined by how patients perceive it, rather than by how much they actually pay for the services they receive. Unlike other markets, health care features payment arrangements that separate consumers from payers

Payers often restrict patient choice to reduce the risk of excessive pharmacy or medical cost and also to ensure that prescribing patterns do not deviate from clinical guidelines.  The solution to balancing patient choice with cost control likely isn’t either imposing narrow restrictions or allowing patients 100% free choice, but a middle ground.  The authors propose that:

A range of therapies might be clinically indicated for a given patient, but they may vary on non-clinical dimensions that matter to them. For instance, some treatment options may require less travel, such as an oral medication versus radiation treatment or surgical treatment versus continuing medical management. Others might possess a lower toxicity profile and fewer side effects, such as fatigue, nausea, pain, or neuropathy. And, some treatments might offer more certain short-term survival benefits, while others offer a riskier bet on the possibility of a longer-term gain. A flexible formulary might allow patients and their physicians to choose among these clinically valid therapies that nonetheless differ in ways that matter to the patient. In this way, the “guard rails” stay up around evidence-based care but become more aligned with the patient experience.

Please read the whole article. Interesting throughout.

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