Consideration for Health Disparities in Value Assessment Frameworks.

Abstract

Cost-effectiveness analysis (CEA) compares interventions based on relative value and is an integral part of value assessment. Despite recommendations for economists to consider disparities in CEAs that impact health-care resource allocation decisions, the perception held by stakeholders is that value assessment frameworks are inconsistent in practice. We reviewed value assessment reports produced by a United States (US)-based value assessment organization to identify how patients and caregiver input may contribute to how the organization considers health disparities. We purposefully extracted and categorized information relevant to health disparities from report sections on Patient and Caregiver Perspectives and Contextual Considerations and Other Potential Benefits to represent the data acknowledged by the organization's patient engagement efforts. We conducted a thematic analysis of the text in these sections and mapped to a health disparities framework endorsed by the National Institute on Minority Health and Health Disparities (NIMHD). Nineteen evidence reports were included in our analysis. We identified 30 equity-related themes from external stakeholder perspectives or acknowledged in the report and 17 equity-related themes that reflect the actions taken by the economic model developers to address health disparities as a formal part of the CEA. We found examples of the value assessment organization explicitly considering health disparities in cost-effectiveness estimates. However, explicit considerations were not consistent across reports and were not necessarily aligned with patient and caregiver input during model development or consistent with the organization's own contextual considerations. Our findings highlight the need for a systematic approach for the consideration of health disparities within a value assessment framework and more transparency around how final cost-effectiveness approaches are determined.