Assessing the value of a specific drug or medical intervention is a complicated, multilayered process. Conventional cost-effectiveness ratios (i.e., in the form of incremental cost per quality-adjusted life years (QALYs) gained) provide a useful starting point for conversation about value, but they cannot reflect all of the elements of value about which different audiences care deeply. Value will always be a multi-dimensional concept and depend on context and stakeholder preferences. As economists continue to explore conceptual issues related to the value of health care treatments, the field should pay closer attention to visual display tools.
By synthesizing complex data into more easily accessible visual formats, well-designed drug value dashboards can aid stakeholders’ understanding of value. As I argue in a recent paper, health care decision makers should be presented with well-designed drug value dashboards containing various metrics – conventional cost per QALY ratios as well as measures of a drug’s impact on clinical and patient-centric outcomes, and on budgetary and distributional consequences – to convey the value of drugs along different dimensions.
Such displays are consistent with consensus guidelines for the field, which emphasize that cost-effectiveness analyses provide one input into a complex and multi-factorial decision-making process. Alongside cost-effectiveness, audiences consider legal, ethical, political, and practical questions, as well as financial constraints and patients’ expectations. Critically, dashboards would supplement, not replace, the details of analyses which would still be present in full reports and appendices.
The question is how to assemble and display efficiently information on such varied dimensions? Drug value assessments can draw from other contexts. Dashboards are omnipresent in our lives – on our phones and in our cars. We use them to inform purchasing decisions and track the COVID-19 pandemic. Consumer Reports has long presented dashboards in its reviews of goods, ranging from SUVs to dishwashers to blood pressure monitors. Dashboards as visualization tools– e.g., in emergency and operating rooms to improve workflow management – have shown promise as decision support aids for clinicians considering different treatment options and for patients judging the risks and harms of prescription drugs.
Economists have advanced different approaches for conceptualizing and presenting cost-effectiveness information, including summary statistics (e.g., incremental cost per QALY ratios, net monetary benefit amounts) and representations of uncertainty in study results (e.g., tornado diagrams, acceptability curves). The Second Panel on Cost-Effectiveness in Health and Medicine proposed an “Impact Inventory” as a visualization tool for revealing whether an economic evaluation included an intervention’s effects on different health and non-health consequences (e.g., economic productivity, social services, legal or criminal justice, education, housing, or the environment).
Summarizing complex concepts in a simple way presents obvious challenges. Dashboards provide no guidance on how to combine the elements for value considerations – i.e., what to do when some drugs rank higher on one metric than others.
The field would benefit from experimentation and should leverage natural tendencies in how people process information into the design. For example, individuals are more likely to remember images and symbols over text, and horizontal over vertical displays (most languages read left to right). Likewise, dashboards should avoid design flaws (excessive text, clashing colors, lack of a clear pattern or “flow”) that result in cognitive overload when the brain cannot process what the eye is seeing because it is receiving more information than it can handle. Designers should balance readability with the need to include all relevant factors in the dashboard (incremental cost-effectiveness ratios, key clinical outcomes, short term budget impacts, and indicators of disease severity, risks, side effects, and patient convenience).
Well-designed drug value dashboards offer promise for presenting a drug’s impact on different dimensions succinctly and effectively. As the field continues to make strides in exploring conceptual issues related to value, it should also consider how best to display and communicate this information drawing important lessons from graphic design.
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.