Use by Different Stakeholders
One of the core goals of Open-Source Value Platform models and their accompanying web interfaces is to help inform the real-world decisions of a variety of stakeholders in the U.S. healthcare market.
All healthcare decision makers require (and deserve) high-quality evidence on treatment benefits and cost to make coverage decisions, negotiate prices, and guide treatment discussions.
And yet, different decision makers face diverse decision contexts. For instance, some cover or treat very sick populations, while others address the needs of patients with milder, earlier-stage disease. Some care exclusively about health gains compared to costs, while other decision makers factor in adjacent outcomes like workplace productivity. Our open-source models provide flexibility to adapt to these different scenarios and needs.
IVI’s Open-Source Value Platform disease-specific models are demonstrations of a flexible approach to value assessments that can provide customized information to a wide range of stakeholders making many different kinds of decisions over time.
A Flexible Modeling Approach at the Individual Level
Open-Source Value Platform models simulate health outcomes and risks associated with sequences of treatment for individual patients within the model, each with their own characteristics, disease course, and health outcomes. The models are designed to be flexible so that:
- Results can be tailored to the unique characteristics (e.g., age, gender, disease activity) of specific populations of interest to a specific user;
- A range of modeling approaches based on the prior academic literature can be selected, analyzed, and debated;
- Users can decide to consider costs to the healthcare system alone or include broader societal costs such as effects on patients’ earnings;
- Important values such as drug prices can be easily edited;
- Users can consider components not usually included in value models—for example, the value of available treatments to the currently healthy, the value of hope, and treatment attributes such as mode of administration.
To ensure that simulated outcomes reflect outcomes in routine practice, IVI models “baseline event rates” (i.e., disease progression, mortality, time spent on a given treatment), patient preferences, and costs using real-world data. To enhance validity, relative treatment effects (i.e., differences in safety and efficacy across difference treatments) are, when possible, based on randomized clinical trials (RCTs).
Application in Value Assessment
Open-Source Value Platform models currently support two approaches to value-oriented decision analysis: cost-effectiveness analysis and multi-criteria decision analysis.
Cost-effectiveness analysis is a well-established approach for comparing the cost and benefits of alternative treatments. The benefits of treatment are typically assessed using the quality-adjusted life year (QALY), a measure that combines a patient’s life expectancy and quality of life. In cases where one treatment may be more likely to improve patient health, but also costs more than another, cost-effectiveness analysis is one quantitative approach for trading off health gains and cost. Decision-makers must determine how much they would be willing to pay for additional health benefits (i.e., the value of a QALY) and a treatment is deemed cost-effective if its cost per QALY is less than the decision-makers willingness to pay threshold.
An alternative approach to value assessment is multi-criteria decision analysis (MCDA), which recognizes that decisions are often made using a number of disparate criteria. MCDA lets decision-makers weight these different criteria (i.e., health outcomes, mode of administration, strength of available evidence, costs) based on their importance to the individual decision-maker. The different treatment options are scored on each criterion, and the decision-makers’ customized weights are then used to generate a single weighted average score for each treatment option.
Different Stakeholders, Different Questions
Spending on healthcare is often an investment with long-term returns, but understanding the broader benefits of healthcare spending decisions requires approaches that include a societal perspective. Open-Source Value Platform models allow users to include societal-level treatment benefits and costs recommended by leading scientists. Examples of these societal value components include productivity effects and benefits that healthy individuals obtain from medical technologies due to the reduced risks of physical harm (also called insurance value).
Health plans and insurers must make complex coverage decisions and negotiate prices that maximize benefits while minimizing cost across their enrolled populations. Every population of enrollees is unique, but information on value and cost-effectiveness is often presented for an “average” patient in the general population. Open-Source Value Platform models provide flexibility in defining population characteristics and adjusting inputs such as prices and rebates to tailor measures of value to a health plan’s unique set of enrollees.
As payers move towards value-based purchasing, provider compensation will increasingly depend on the quality and cost of the care they recommend. With new value-based payment models, providers need to understand the relative benefits and costs of different treatment strategies at a practice level, as well as the risk of side effects and serious adverse events. Open-Source Value Platform models synthesize evidence sources to allow providers to examine the long-term health benefits, potential costs, and side effect risks of different treatment sequences/strategies.
Open-Source Value Platform models leverage evidence from both clinical trials and real world data to ensure that measures of treatment value are up-to-date and relevant to real-world clinical practice. Furthermore, these models examine the value of sequences of treatment – not simply head-to-head comparisons – which can provide valuable insights into how therapies contribute to value over the course of a patient’s care. While life science users are able to run analyses using IVI’s online interfaces or R packages, analysts can also create fully customized analyses using the underlying source code.
Value-based care initiatives are changing coverage and reimbursement across whole populations, but patients are also seeking the treatments that are most valuable to them. IVI’s Open-Source Value Platform (OSVP) models are developed in partnership with patients, and IVI is at the leading edge of efforts to measure and include patient-determined components of value. OSVP models also allow users to explore how their priorities and concerns affect the relative value of treatment sequences through Multi-Criteria Decision Analysis (MCDA). While this approach cannot provide definitive answers about the most valuable treatment for a given patient – this should ultimately be determined through shared decision-making with a physician – it can provide a valuable opportunity to think through what is most important in a patient’s treatment goals and examine how those preferences may affect results.