Entities such as the Panel on Cost Effectiveness in Health and Medicine have argued that we should include the societal perspective when measuring the value of a certain treatment through cost-effectiveness analysis (CEA). However, societal perspective is not always the one used. Further, even when the societal perspective is taken, this is often limited to incorporating productivity losses and caregiver burden.
One group who is not traditionally mentioned in CEA is patients. Yet, patients are the most important stakeholders in the health care system. Nevertheless, CEA models may measure patient quality of life using generic utility metrics–e.g., those derived from EQ-5D–which may have poor sensitivity for how different treatments affect the quality of life for patients with a specific disease.
A paper by Slejko et al. (2019), argues that a patient-informed societal perpsective is needed. What does that mean?
Well, one way to better capture patient preferences is to use more disease specific survey metrics to quantify patient tradeoffs across treatment attributes.
In fact, there are data showing that stated preference methods, like a discrete choice experiment, render important information about treatment value to which traditionally derived QALYs are not sensitive. For example, the value sets for preference instruments can be estimated with discrete choice experiments.24 Furthermore, it is important to examine whether the domains measured by instruments used for QALY estimation reflect attributes of interest to patients.
The authors also not while patient input is already included as part of standard CEA, more could be done. For instance, incorporating novel elements of value such as ability to plan, convenience, and effects on family. Even if all value components are included in a model, having patient input into the CEA model is helpful. In particular, information about the patient journey can be useful for defining model health states as well as relevant time horizons.
In short, as patients are the ones who are the end users of our health care system, it is important that they have a same in terms of how treatments are valued.