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Joshua Cohen, PhD

Joshua Cohen VA Center 2019
Center of Excellence in Value Assessment and Health Outcomes Research, 2019 Tufts University

The Center for Enhanced Value Assessment (CEVA)


The Center for Enhanced Value Assessment (CEVA) sits within the Center for the Evaluation of Value and Risk in Health (CEVR) at Tufts Medical Center and serves as a platform to focus on a relatively recent phenomenon: namely, the proliferation of health technology value assessment frameworks in the United States. CEVA’s mission is to explore the quantitative implications of incorporating non-traditional value elements into cost-effectiveness analyses. CEVA will also characterize stakeholder preferences related to novel value elements through the engagement of patients, health insurance companies, and therapeutic area leaders. By seeking to account for all elements of value that matter to decision makers, CEVA will help decision makers as they consider coverage and reimbursement of new technologies. CEVA has four broad aims: 1) quantify the extent to which published CEAs include broader elements of value; 2) develop case studies to incorporate broader elements of value into existing CEA models; 3) conduct a patient and stakeholder survey; and 4) create a user-friendly “dashboard” display. In the first year of the project, we analyzed more than 8,000 studies catalogued in the Tufts Medical Center’s CEA Registry (a database of cost-per-quality-adjusted-life-year [QALY] studies) and in the Global Health CEA Registry (a database of cost-per-disability-adjusted-lifeyear [DALY] studies) to determine how often published CEAs have included novel elements like patient time, transportation costs, productivity, and other non-healthcare sector impacts. We compared the cost-per-DALY and cost-per-QALY literature with regard to their inclusion of these elements, the perspective used, and intervention types. Results show that the health care sector perspective was most prevalent in the CEA literature, but many studies have not clearly stated the perspective used. This work was featured in presentations at several conferences in 2019, including the International Health Economics Association (Basel), the Society for Medical Decision Making (Chicago), and the PhRMA Foundation-National Health Council Conference on New Approaches to Value Assessment (Washington, DC). We are in the process of conducting several case studies to quantify the impact of including novel value elements, such as the value of hope, insurance value, option value, and caregiver impact.

The CEVA team, from left to right: David Kim, PhD; Anna Legassie; Natalia Olchanski, PhD; Joshua Cohen, PhD; Daniel Ollendorf, PhD; Peter Neumann, ScD, and Madison Silver

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