Are PBM exclusion lists value-based?

Value-based insurance design (VBID) is a simple concept.  In short, interventions that provide high-value should be covered with little cost sharing; treatments with low-value should be covered with higher rates of cost sharing or in some cases perhaps not even covered at all. A paper by Cohen et al. (2017) aims to see how far…

What is the value of a QALY?

Many new treatments deliver significant benefits to patients.  In many cases, however, the new treatments may be more expensive.  How do we know if a treatment is worth the cost? Cost effectiveness analysis helps us answer this question.  Cost is fairly easy to calculate but benefits are more complicated.  A treatment could extend a person’s…

Cost-Effectiveness Analysis 2.0

High drug prices are in the spotlight. While expensive, many of these treatments improve patients quality of life and even extend patient’s life expectancy. How do you balance treatment cost and benefits? Peter Neumann and Gillian Sanders have a perspective piece in NEJM describing the findings of the Second Panel on Cost-Effectiveness in Health and…

Adding the patient perspective to health technology assessment

Health technology assessments (HTAs) aim to measure the cost effectiveness of a given treatment or set of treatments for a specific patient populations.  Often, these assessments are conducted from the point of view of the payer–either a national health system or the individual insurer perspective.  This payer focused perspective can often focus largely on treatment costs rather…

Extended Cost Effectiveness Analysis

Cost effectiveness analysis (CEA) examines whether treatment benefits outweight treatment costs on average for a given patient population. A 2016 paper by Verguet, Kim and Jamison examine the concept of extended cost effectiveness analysis (ECEA) which applies cost effectiveness methodologies to health care policies. The policies are evaluated over 4 domains: (1) health gains; (2)…

High quality comparative effectiveness research

What are the best practices for conducting comparative effectiveness research in the real-world?  One proposed best practice guildelines are the Good Research for Comparative Effectiveness (GRACE) guidelines.  However, most studies do not follow these guidelines.  A paper by Dreyer, Bryant and Velentgas (2016) assembled 28 observational comparative effectiveness articles published from 2001 to 2010 that compared treatment effectiveness and/or…