The Evolving Assessment of “Value” in Health Care

Tracking the Evolution of Value

Glasgow, Scotland, UK
—8 November 2017—ISPOR, the professional society for health economics and outcomes research (HEOR), held the third plenary session, “Evolution of Value: Perspectives From Both Sides of the Atlantic” at its 20th Annual European Congress in Glasgow, Scotland, UK this morning.

The plenary discussion was moderated by Shelby D. Reed, PhD, RPh, Duke University, Durham, NC, USA. Speakers included Jérôme Wittwer, PhD, Bordeaux University, Bordeaux, France; Mandy Ryan, PhD, MSc, College of Life Sciences and Medicine, University of Aberdeen, Aberdeen, UK; and Charles E. Phelps, PhD, University of Rochester, Gualala, CA, USA.

In this plenary, health economists from the United Kingdom, United States, and France discussed how health systems across a variety of countries approach and define “value” in health care. While most health care systems claim that they link coverage decisions based on value, their approaches to valuation can differ dramatically.

Speakers noted that many countries, such as the United Kingdom, have historically relied on traditional cost-effectiveness analysis to guide their coverage decisions. Other countries such as France and Germany have taken a different approach, relying instead on disease-specific metrics. In contrast, the majority of payers in the pluralistic health care market in the United States deny explicit consideration of cost effectiveness in their coverage decisions. The approach of public and private payers in the United States has been to increasingly move financial risk onto health care providers, which results in a decentralization of value assessment.

Charles E. Phelps, PhD spoke on the topic, “Use and Non-Use of Cost-Effectiveness Analysis in the United States.” He pointed out that cost-effectiveness analysis (CEA) is, “like the weather; everybody talks about it, but nobody does anything about it.” Dr. Phelps noted that the United States has a vast outpouring of studies and educational programs focused on CEA, however very little use of CEA actually occurs in the country. While a number of reasons account for the low use of CEA, the United States’ aversion to explicit rationing of health care is behind it all.

Jérôme Wittwer, PhD spoke on, “Valuing Health in France: Something New?.” He explained that until recently, CEA was poorly known and not well accepted by stakeholders in France with the barrier being that only clinical  criteria are used for reimbursement decisions in the country. CEA in France started moving, albeit slowly, due to a political impetus 10 years ago when the Financial Law of Social Security determined that the Health French Agency had to design cost-effective health care strategies.

Mandy Ryan, PhD, MSc spoke on the topic of, “Valuation in Health Economics: Reflections of a UK Economist and Patient.” She pointed out that health economists are “wedded to the quality-adjusted life year (QALY),” however, in some areas of health care (such as dental care) economists need to look beyond the QALY. Dr. Ryan noted that instead, health economists should ask, “what should we as economists be valuing?.” She also provided her reflections as a patient on the importance of engaging patients in health care.

Additional information on the ISPOR 20th Annual European Congress can be found here. Released presentations from the congress can be found here. Interested parties can follow news and developments from the congress on social media using the hashtag #ISPORGlasgow.



ISPOR, the professional society for health economics and outcomes research (HEOR), is an international, multistakeholder, nonprofit dedicated to advancing HEOR excellence to improve decision making for health globally. The Society is the leading source for scientific conferences, peer-reviewed and MEDLINE-indexed publications, good practices guidance, education, collaboration, and tools/resources in the field.
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