We have so much work to do that relates to discovering the relative benefits and risks of how we treat disease that when we integrate costs into the equation, it becomes very difficult to have a rational discussion about value. We tend to immediately jump to arguments about cost-effectiveness thresholds and how to interpret quality-adjusted life years, forgetting that all of these things are currently based on extremely uncertain estimates of just what the risks and benefits are.
Decision-making would benefit from our spending more time and money on concrete ways to improve our knowledge of health risks and benefits, like improving our clinical trial system and advancing our health information technology capabilities. Once we have less uncertainty about these clinical effectiveness questions, we can at least have a more informed argument about the relative costs of achieving those benefits or avoiding those risks.
When people actually listen to each other, common understanding begins to materialize. So we need to provide more opportunities for stakeholders to have meaningful dialogue about issues of research priorities and study design. It can’t be done effectively if there continue to be separate conversations in separate forums.
That said, payers are naturally going to look at value on a population level, patients judge value on a very personal level, and clinicians are increasingly caught in the middle. There are going to be persistent differences of opinion on what defines value in health care. But if we think in terms of specific clinical benefits such as quality of life, survival, or patient experience with side effects, there is likely to be more convergence about the meaning of clinical value. Building consensus across stakeholder groups about specific benefits through more sustained interaction is a good start.