Patient Perspective Value Framework
As the cost of health care continues to rise, understanding, obtaining, and paying for value has become an increasingly critical issue. In recent years, several organizations have put forward new approaches to evaluate and assess the value of medical interventions. However, these existing frameworks are largely built on a traditional definition of value that does not adequately incorporate and reflect the patient perspective. This is why FasterCures and Avalere Health partnered to develop the first patient-centered value framework.
The newly released Patient Perspective Value Framework (PPVF) incorporates measures of benefits and costs in the context of patients’ personal goals and preferences to assess the value of different health-care treatment options.
Domains of Value and Technical Criteria
The PPVF has five broad domains of value, each of which contributes different types of information important to patient decision-making.
Within each domain is a set of technically specified criteria.
These criteria are narrower components of value that constitute a domain. As the PPVF is operationalized for a particular application, the criteria are used to assess each domain.
1. Patient Preferences: This domain assesses a patient’s personal goals and preferences and functions as a lens through which the PPVF views the Patient-Centered Outcomes, Patient & Family Costs, and Quality & Applicability of Evidence associated with different health-care options.
- Goals & Expectations
- Financial trade-offs
2. Patient-Centered Outcomes: This domain assesses the clinical, functional, and quality of life benefits and drawbacks of different health-care options to the patient.
- Quality of life
- Complexity of regimen
- Efficacy & Effectiveness
- Safety: side effects & complications
3. Patient and Family Costs: This domain assesses the medical, non-medical, and future out-of pocket costs and other financial considerations and burdens associated with different health-care options
- Medical out-of-pocket costs
- Non-medical costs to the patient/family
- Future costs of care
4. Quality and Applicability of Evidence: This domain assesses the strength and consistency of the evidence, as well as the degree to which the evidence applies to the individual patient and functions as a lens through which we view the Patient-Centered Outcomes and Patient & Family Costs domains.
- Quality of evidence
- Consistency of evidence
- Differences in treatment effect
5. Usability and Transparency: This domain serves as a foundation for the PPVF and assesses the usability of the framework for its intended audience and transparency of the framework’s approach.
- Transparent approach
- Meaningful information
- Accessible format
Measures, Data Sources, and Methods
Each criterion is assessed through a set of data sources, measures, and methods, as laid out in more detail here. The PPVF differs from other frameworks in that it allows for the consideration of various sources of evidence beyond randomized controlled trials. Wherever possible, PPVF assessments will use real-world evidence, patient-reported data, and other data sources in addition to clinical trial data.
How We Developed the PPVF
Avalere and FasterCures conducted a workshop at Partnering for Cures examining existing value frameworks and the degree to which they incorporate patient perspectives. The consensus was clear: the patient perspective was not adequately incorporated in current frameworks.
In March, FasterCures and Avalere published Integrating the Patient Perspective into the Development of Value Frameworks to outline our efforts to date while also issuing an action plan for developing a patient-perspective value framework responsive to the concerns voiced at the 2015 workshop.
In June, Phase I of the PPVF launched with the formation of a multi-stakeholder steering committee with representation from 23 different organizations, including patient groups, payers, life sciences companies, and other policy and research organizations.
In November, the draft methodology report and infographic were released at Partnering for Cures, and a public comment period was opened. More than 100 comments were submitted, with more than 60 percent of comments coming from patients and patient advocates.
In January, Avalere and FasterCures conducted direct outreach to patients to receive feedback on the draft PPVF and test the language used in the PPVF summary infographic directly with patients.
In February, a second in-person steering committee meeting was held to address revisions to the PPVF as well as conduct an interactive discussion with existing framework developers from the American Society of Clinical Oncology, National Comprehensive Cancer Network, Institute for Clinical and Economic Review, and Drug Abacus.
The PPVF’s Future:
FasterCures is proud to again partner with Avalere as the PPVF initiative moves into Phase II. Phase II will run from 2017 through 2018 and will focus on refining, testing, and validating the PPVF in real-world settings. In particular, we expect the PPVF initiative to focus on validating a quantitative scoring methodology, piloting specific applications, making revisions based on those pilots, and continuing collaborative efforts with other framework developers. We look forward to working with Avalere and the rest of the Steering Committee to identify, map out, and execute the full scope of activities for this important next Phase.