People may hear the terms health economics and outcomes research (HEOR) and health technology assessment (HTA) and believe they are interchangeable. While both are rooted in value assessments of health technologies, the two disciplines are different. They are different in terms of perspective, scope, and their intended audiences.
First, in terms of perspective, HEOR takes a “health system” perspective. This means HEOR studies concentrate on the direct costs and benefits of new health technologies that accrue to the health system and the patient. The scope tends to be fixed on how the new technology, patient, and disease interact to produce therapeutic benefits and their costs relative to a comparator.
On the other hand, HTA’s perspective tends to be broader, typically a “societal” perspective that includes both direct and indirect costs and benefits into assessments. The scope of HTA is often expanded to other indirect effects of the technology, ethical implications, organizational impacts, and the amount of societal good that may be derived from the adoption of particular health technologies.
In the United States, several organizations have taken up the banner of value assessment. The Drug Pricing Lab at Memorial Sloane Kettering focuses specifically on drugs to treat cancer using Drug Abacus. The National Comprehensive Cancer Network (NCCN) publishes The NCCN Evidence Blocks™ along with their well-regarded cancer treatment guidelines. The American Society of Clinical Oncology (ASCO) Value Framework is based on the concept of net clinical benefit. While different in terms of process of valuation and their intended effect on decision-making, all fall into the HEOR camp. All look at cost benefits within the framework of a health system perspective. The Drug Pricing Lab aims to stimulate conversation about drug prices with plans and governmental purchasers. NCCN and ASCO are aimed at facilitating choice of therapy made by physicians and their patients.
In the United States, organizations conducting HTAs are not common. Over the years, Institute for Clinical and Economic Review (ICER) has evolved its value framework to explicitly include aspects of the societal perspective in reviews. It may not be an HTA body in the purest sense, but at this time ICER is arguably the most influential organization of its kind in the US healthcare environment. Its aim is to help ensure health technologies are priced fairly and are fairly accessible without sacrificing future innovation.
Value, like beauty, it seems, is in the eye of the beholder. So, what are health technology companies supposed to do?
The good news is that evidence of clinical efficacy and safety needed for marketing approval is necessary to each value framework. The bad news is that this information is not sufficient value assessment in either HEOR (or HTA).
Designing a development program that integrates stakeholder input from payers and patients will help make sure meaningful humanistic outcomes can be built into development programs, so that initial value can be assessed at or shortly after launch of the technology.