1 National Pharmaceutical Council, Washington, DC.
J Manag Care Spec Pharm. 2017 Jun;23(6-a Suppl):S28-S33. doi: 10.18553/jmcp.2017.23.6-a.s28.
As the United States transitions from a volume-based health care system to one that rewards value, new frameworks are emerging to help patients, providers, and payers assess the value of medical services and biopharmaceutical products. These value assessment frameworks are intended to support various types of health care decision making. They have the potential to substantially affect patients, whether as tools for shared decision making with their doctors, as an input to care pathways used by providers, or through payer use of the frameworks to make coverage or reimbursement decisions. Prominent among current U.S. value assessment frameworks are those developed by the American Society of Clinical Oncology, the Institute for Clinical and Economic Review, the Memorial Sloan Kettering Cancer Center, and the National Comprehensive Cancer Network. These frameworks generally reflect the interests and expertise of the organizations that developed them. The evidence, methodology, and intended use differ substantially across frameworks, which can lead to highly variable determinations of value for the same treatment therapy. To demonstrate this variability, we explored how these frameworks assess the value of treatment regimens for multiple myeloma. Cross-framework comparisons of multiple myeloma assessments were conducted, and consistency of findings was examined for 3 case studies. A discussion of the analysis explores why different frameworks arrive at different conclusions, whether those differences are cause for concern, and the resulting implications for framework readiness to support health care decision making.
Funding for this project was provided by the National Pharmaceutical Council. The authors are employees of the National Pharmaceutical Council, an industry-funded health policy research group that is not involved in lobbying or advocacy. Study concept and design were contributed by Westrich and Dubois, along with Buelt. Westrich took the lead in data collection, along with Dubois, and data interpretation was performed by all the authors. The manuscript was written by Westrich and Buelt, along with Dubois, and revised by all the authors.
随着美国从基于数量的医疗保健系统向奖励价值的系统转变，新的框架正在出现，以帮助患者、提供者和支付者评估医疗服务和生物制药产品的价值。这些价值评估框架旨在支持各种类型的医疗保健决策。它们有可能对患者产生重大影响，无论是作为与医生共同决策的工具，还是作为提供者使用的护理路径的输入，还是通过支付者使用这些框架来做出覆盖范围或报销决策。目前在美国，突出的价值评估框架包括美国临床肿瘤学会、临床和经济审查研究所、纪念斯隆凯特琳癌症中心和国家综合癌症网络开发的框架。这些框架通常反映了开发它们的组织的利益和专业知识。证据、方法和预期用途在不同的框架之间有很大的差异，这可能导致对同一治疗方案的价值有非常不同的判断。为了证明这种可变性，我们探讨了这些框架如何评估多发性骨髓瘤治疗方案的价值。对多发性骨髓瘤评估进行了跨框架比较，并对 3 个案例研究的发现一致性进行了检查。对分析的讨论探讨了为什么不同的框架会得出不同的结论，这些差异是否值得关注，以及这些差异对框架准备支持医疗保健决策的影响。
本项目的资金由国家制药理事会提供。作者是国家制药理事会的员工，该理事会是一个行业资助的健康政策研究小组，不参与游说或宣传。Westrich 和 Dubois 以及 Buelt 提出了研究概念和设计。Westrich 与 Dubois 一起负责主要数据收集，数据解释由所有作者共同完成。手稿由 Westrich 和 Buelt 与 Dubois 共同撰写，并由所有作者修订。
