Value Assessment Tools: What Is Valuable to Payers?

The transition toward value-based payment in the United States has led to the emergence of value assessment tools aimed at measuring the value of health care interventions. To understand the impact of these tools on treatment and coverage decisions, a study was conducted to examine payer perceptions and utilization of these tools.

The study employed a double-blind, web-based survey conducted from June 2022 to July 2022. The survey focused on evaluating the perceptions and use of value assessment tools developed by various organizations, including the American Society of Clinical Oncology, Drug Pricing Lab, Institute for Clinical and Economic Review (ICER), Innovation and Value Initiative, and National Comprehensive Cancer Network. A total of 51 respondents completed the survey.

The results showed 86% of payers were familiar with at least 4 out of the 5 value assessment tools mentioned. Among the tools, both ICER and the National Comprehensive Cancer Network were perceived as highly useful for informing formulary decisions by 57% and 49% of respondents, respectively.

When selecting a value assessment tool, payers considered the inclusion of appropriate metrics and outcomes, comparative clinical effectiveness information, and reliance on rigorous, unbiased methods as highly important factors. On the other hand, the inclusion of patient, provider, and societal perspectives was deemed less important by many respondents.

Payers reported utilizing ICER evidence reports to both expand and restrict coverage decisions. To improve the relevance and usefulness of value assessment tools, payers suggested the need for greater stakeholder awareness of existing tools. Some respondents also recommended increasing the volume of assessments conducted by value assessors.

Researchers concluded US health care payers perceive certain value assessment tools to be valuable in informing health care decisions. However, as the policy momentum behind value assessment continues to grow, further examination of these tools is necessary to ensure their appropriate application in US health care decision-making, the investigators said.

Reference:
Westrich K, Hydery T, Dharbhamalla V, et al. Payer perceptions and use of value assessment tools in the United States. J Manag Care Spec Pharm. 2023;29(5):582-588. doi:10.18553/jmcp.2023.29.5.582