Value Assessment Research Should Consider Societal Consequences
Value assessment formally quantifies health care intervention benefits alongside their costs and risks to make recommendations about value-based pricing and reimbursement decisions. This framework can also be used to assess non-medical or pharmaceutical interventions, such as governmental health policy decisions.
As a consequence of the COVID-19 pandemic, most governments around the world have implemented some form of social distancing mandates in an attempt to slow the spread of the virus. While public health experts widely agree that these policies are warranted, it is nevertheless important to consider trade-offs of such measures, including their economic impact, as well as to ensure that the underlying data and assumptions reasonably capture all relevant benefits and costs.
Our recent letter in Medical Decision Making argues that evaluations of social distancing and other policies should account for the broad non-health consequences of these interventions to generate reliable and comprehensive estimates of their impact on society. These social consequences, which include factors such as the effect of these policies on labor markets, consumption, the legal/criminal justice system, education and the environment are typically not reflected in analyses that only focus on the impact to the health care sector. Therefore, evaluations that only account for factors such as mortality or changes in patient outcomes present an incomplete picture of the impact of social distancing policies and their effects on society.
One strategy to ensure that economic evaluations consider both health care and societal perspectives is to create an impact inventory listing the intervention’s health and non-health consequences to help standardize the practice and reduce confusion.
This approach was recommended by the Second Panel on Cost-Effectiveness in Health and Medicine and has been successfully used, for example, in evaluations of pharmacotherapy for patients with alcohol-use disorder that found benefits of the intervention beyond health care outcomes including improved patient productivity and reduced alcohol-related motor vehicle crashes. Another example that appeared in the American Journal of Preventive Medicine is an evaluation of the cost-effectiveness of implementing tax and warning labels on processed meats. The study highlights the importance of capturing broader societal consequences, including increased productivity and reduced time costs to seek or undergo treatment through more cancer cases averted.
Applying this approach to evaluate social distancing policies and health care interventions such as antiviral treatments or vaccines, we might find negative societal impacts such as a decrease in quality of life due to social isolation—including increased substance use, domestic violence and poor mental health—as well as declines in worker productivity. However, there could also be positive societal impacts, such as a decrease in pollution and automobile crashes due to reduced driving.
The impact inventory and other methods to measure societal impacts should be considered in economic evaluation of health care interventions to present a more comprehensive assessment. Our colleagues at the Center for the Evaluation of Value and Risk in Health at Tufts Medical Center and the Center for Enhanced Value Assessment are working on incorporating broader elements of value into cost-effective analyses to further the goal of ensuring that our country’s ongoing transition to value-based care truly captures all elements of importance to patients, stakeholders and society.
Research conducted by the Center for Enhanced Value Assessment (CEVA) is made possible in part by funding from the PhRMA Foundation as part of its Value Assessment Initiative.
About the Authors
David D. Kim, PhD, is Program Director, CEA Registry, Center for the Evaluation of Value and Risk in Health (CEVR), Institute for Clinical Research and Health Policy Studies; Tufts Medical Center; and is an Assistant Professor at Tufts University of School of Medicine.
Peter J. Neumann, ScD, is Director, Center for the Evaluation of Value and Risk in Health (CEVR), Institute for Clinical Research and Health Policy Studies; Tufts Medical Center; and is a Professor at Tufts University of School of Medicine.