Incorporating Patient Preferences into the Field of Value Assessment
Although I was trained as a pharmacist and studied health economics, early work in my career with multiple sclerosis patients helped me understand that value in health care is a lot more complex than traditional clinical evidence metrics or economic models and tools might suggest. Further, living in different parts of the world and witnessing dramatic health disparities has helped me as a researcher to better understand the interplay of quality of care, access, economic value, and patient preferences.
Understanding how patients perceive a medicine’s value is a bit like understanding the value children feel from their stuffed animals. Just as adults or other children may see a ratty old teddy bear as worthless, it means the world to the child who sleeps with it every night. Similarly, two children could walk by the same stuffed rabbit in the toy store and have very different reactions. One might shrug and keep walking, while to the other, it is the most important toy in the world, and they must have it RIGHT NOW.
To some extent, the same is true in medicine. A treatment with terrible side effects might be highly valued by a cancer patient with no other options (like the ratty old teddy bear, or the child who throws a tantrum to have the stuffed rabbit). However, another patient with the same options and the same outcomes may perceive the treatment as less valuable because of the changes to their quality of life it brings (like the child who walks past the rabbit with no interest).
After I trained as a pharmacist, I became very interested in questions of health economics as I began to understand the ways in which payers must evaluate evidence when making a payment decision. There will always be tradeoffs and clinical evidence must always be considered, but how can patient preferences be captured? Even if we have more evidence of patient preferences, how can we leverage these insights?
I am grateful for the support of the PhRMA Foundation for their role in catalyzing the conversation around value in health care and funding researchers like myself working to advance the field of value assessment with new approaches to quantifying value and new thinking about how to apply evidence of patient preferences. Compared to other forms of clinical evidence generation, the process of developing models of patient preferences and standards around the use those models is a new field very much still coming into focus.
Advancing the value conversation will require much research and consideration, as well as a pipeline of new researchers to enter this exciting field at the intersection of health care, economics, and helping people maximize their enjoyment of life.
Surachat Ngorsuraches is Associate Professor of Health Outcomes Research and Policy at the Auburn University Harrison College of Pharmacy. He has received support for his value assessment research from the PhRMA Foundation and was the 2nd-place winner of the Foundation’s 2021 Value Assessment Challenge Award.