A Value Proposition For Specialty Medications

Newark, DE, USA – Hospitals, physicians, payers and patients face economic and ethical decisions about the use of biotechnology drugs, commonly called specialty medications. Medicare, physician guidelines and consensus statements currently include specialty drugs without an assessment of value, resulting in unintended consequences such as high costs with questionable evidence to support the overall value of the medication. Due to the absence of a national agency performing cost-effectiveness reviews, decisions about specialty drugs must be made on a local level. Researchers at Christiana Care Health System developed a point-based algorithm to evaluate certain drugs based on their cost per course per patient, evaluating the effectiveness, risk, cost and societal benefit of the drug.

The researchers designed a new model that factors in medication effectiveness and the input of society to bend the cost curve and determine which specialty drugs provide value for the patient.

In the article, “Deciding Which Drugs Get Onto the Formulary: A Value-Based Approach,” the researchers describe the process and outcomes using a new value model for evaluating specialty medications for a hospital formulary. The model introduces a new criterion of evaluation entitled “Societal Benefit” which provides a rating on quality-of-life issues. Including in our methodology the quantifiable core components of efficacy, risk, cost and quality of life, Christiana Care has created a balanced and effective approach in evaluating the value of specialty medications.

“Our model takes a balanced approach to measuring value for each patient,” said Ray Seigfried, Senior Vice President of Administration for Christiana Care, and lead author on the study. “In our model, not only do we evaluate the quality and safety and cost of the specialty medications, but we go a step further to take into consideration the societal benefit. From a patient’s perspective, the quality of life is very important and it is very important that we take that into consideration.” For more information on Christiana Care Health System, please see: http://www.christianacare.org/

Value in Health (ISSN 1098-3015) publishes papers, concepts, and ideas that advance the field of pharmacoeconomics and outcomes research as well as policy papers to help health care leaders make evidence-based decisions. The journal is published bi-monthly and has over 8,000 subscribers (clinicians, decision makers, and researchers worldwide).

International Society for Pharmacoeconomics and Outcomes Research (ISPOR) is a nonprofit, international, educational and scientific organization that strives to increase the efficiency, effectiveness, and fairness of health care resource use to improve health.

For more information: www.ispor.org

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