Existing Value Assessment Frameworks Vary in Defining and Measuring Value in Health Care

Study findings show substantial variation in defining and measuring value among existing value assessment frameworks in health care, showing a tendency toward aggregating multiple value attributes into a single index for decision making (Value Health. 2022;25[2]:302-317. doi:10.1016/j.jval.2021.07.005).

“The goal of value assessment is to promote an efficient and equitable health care system. Nevertheless, there is no global consensus on how to define and measure value in health care,” wrote Mengmeng Zhang, MSc, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada, and colleagues. 

This study aimed to investigate how value is defined and measured in existing value assessment frameworks in health care.

Between 2008 and 2019, Zhang and colleagues searched for studies on PubMed, Embase, the Cochrane Library, and Centre for Reviews and Dissemination, and conducted backward citation chaining of the selected studies reporting on the development of value assessment frameworks in health care and previously published systematic reviews. 

Context, target users, intended use, methods used to identify value attributes, description of the attributes, and attribute scoring approaches were analyzed and compared. 

A total of 57 value assessment frameworks were included in this assessment. Among those selected, 2 value assessment frameworks used broad attributes or user-defined attributes, while the value attributes of the remaining 55 value assessment frameworks were grouped into 9 categories: health benefits (n = 53, 96%), affordability (n = 45, 82%), societal impact (n = 42, 76%), burden of disease (n = 36, 65%), quality of evidence (n = 32, 58%), cost-effectiveness (n = 31, 56%), ethics and equity (n = 27, 49%), unmet needs (n = 21, 38%), and innovation (n = 15, 27%).

Value attributes in 36 value assessment frameworks were mainly identified through literature review. The development of 11 value assessment frameworks included patient or public engagement. Among the 29 value assessment frameworks scored using weighting, 19 used the methods of multicriteria decision analysis. 

“There are substantial variations in defining and measuring value,” wrote Ms Zhang and colleagues. 

“A noticeable weakness of existing VAFs [value assessment frameworks] is that patient or public engagement was generally very limited or missing in framework development process. Existing VAFs tend to aggregate multiple value attributes into a single index for decision making,” they added.