van den Broek-Altenburg Eline M, Atherly Adam J
University of Vermont, Burlington, VT, United States.
Virginia Commonwealth University, Richmond, VA, United States.
J Med Internet Res. 2025 Jan 10;27:e60443. doi: 10.2196/60443.
Health care is undergoing a "revolution," where patients are becoming consumers and armed with apps, consumer review scores, and, in some countries, high out-of-pocket costs. Although economic analyses and health technology assessment (HTA) have come a long way in their evaluation of the clinical, economic, ethical, legal, and societal perspectives that may be impacted by new technologies and procedures, these approaches do not reflect underlying patient preferences that may be important in the assessment of "value" in the current value-based health care transition. The major challenges that come with the transformation to a value-based health care system lead to questions such as "How are economic analyses, often the basis for policy and reimbursement decisions, going to switch from a societal to an individual perspective?" and "How do we then assess (economic) value, considering individual preference heterogeneity, as well as varying heuristics and decision rules?" These challenges, related to including the individual perspective in cost-effectiveness analysis (CEA), have been widely debated. Cost-effectiveness measures treatments in terms of costs and quality-adjusted life-years (QALYs), where QALYs assume that a health state that is more desirable is more valuable, and therefore, value is equated with preference or desirability. QALYs have long been criticized for empirical and conceptual shortcomings. However, policy makers in many countries have used QALY measures to make health coverage decisions, although now, patients, and patient advocates, are questioning the valuation methodologies. This has led to the development of new approaches to valuing health, which are already starting to be used in the United States. This paper reviews 20-25 years of value assessment approaches in health and concludes with challenges and opportunities for value assessment methods in health in the years to come.
医疗保健正在经历一场“革命”,患者正成为消费者,他们有各种应用程序、消费者评价分数,而且在一些国家,还面临高额的自付费用。尽管经济分析和卫生技术评估(HTA)在评估新技术和程序可能影响的临床、经济、伦理、法律和社会层面已经取得了长足进展,但这些方法并未反映出在当前基于价值的医疗保健转型中评估“价值”时可能很重要的潜在患者偏好。向基于价值的医疗保健系统转变带来的主要挑战引发了诸如“通常作为政策和报销决策依据的经济分析将如何从社会视角转向个人视角?”以及“考虑到个体偏好异质性以及不同的启发式方法和决策规则,我们如何评估(经济)价值?”等问题。这些与在成本效益分析(CEA)中纳入个人视角相关的挑战已经得到广泛讨论。成本效益从成本和质量调整生命年(QALYs)的角度衡量治疗效果,其中QALYs假定更理想的健康状态更有价值,因此,价值等同于偏好或合意性。QALYs长期以来因实证和概念上的缺陷而受到批评。然而,许多国家的政策制定者已使用QALY措施来做出医保覆盖决策,尽管现在患者及患者权益倡导者正在质疑估值方法。这导致了评估健康价值的新方法的发展,这些方法已开始在美国使用。本文回顾了20 - 25年来健康领域的价值评估方法,并以未来几年健康价值评估方法面临的挑战和机遇作为结论。