In late January, we sat down with Michael Ward from of IVI’s newest members, The Alliance for Aging Research. We are so pleased to partner with such a dynamic organization.
Thank you so much for speaking with us today. Could you tell us a little bit about the Alliance for Aging Research?
The Alliance for Aging Research started over 30 years ago to promote research and scientific discoveries to improve the lives and well-being of older adults. The Alliance believes that research-enabled advances help people live longer, happier, more productive lives and reduce health care costs over the long term. Further, access to the latest scientific information empowers people to take control of their health.
The Alliance is renowned for our award-winning, high-impact educational awareness campaigns and leadership in advocacy efforts that improve the health and well-being of older adults and their caregivers. The Alliance regularly convenes the leading medical experts, researchers, scientists, policymakers, and patient advocates to address health-related issues that impact older Americans. We have also successfully led endeavors to substantially increase funding and focus for aging-related research at the National Institutes of Health and Food and Drug Administration.
What is the top priority for the Alliance to improve value assessment today?
Our top priority is to change the conversation around value assessment. Some believe that the quality-adjusted life year, or “QALY,” is the gold standard for value assessment. However, it is a blunt and reductive instrument that fails to meaningfully incorporate the perspective of patients. Further, when QALY is utilized in coverage and pricing decisions, the methodology results in discrimination impacts against older adults and individuals with a disability or chronic condition. In short, QALY-based assessment is just not up to the task. We need better research and understanding to meet the complex needs of patients and their caregivers.
What is the biggest challenge in value assessment?
One of the biggest challenges in value assessment is the almost universal acceptance and use of health state preference values. Traditional health economics measures the health value of the person(s) who the medical product or service is designed for and the estimated amount of time they may use it to help answer the question “what is this worth?” This model only considers current productivity in its estimation of value, so a lifetime of previous productivity does not count nor does it measure non-economic productivity. It is inherently biased against older adults, people with disabilities, and populations that experience social disadvantage, and routinely assesses individuals in these groups as less cost-effective to treat. Such cost-effectiveness analyses distort our ethical instincts by focusing our minds on life-years rather than people’s lives. It is more often than not a losing proposition for anyone who is not young and in good health.
Is there anything else that you would like to share with us about the Alliance’s current work in the value assessment space?
There are some critical healthcare policy questions around coverage ad access that we will be addressing to inform national discussions on the value of healthcare. For example, we are currently analyzing the role of value assessment for treatments for Alzheimer’s disease. Under present methods, treatments for Alzheimer’s will rarely be evaluated as cost-effective due to the advanced age of many individuals suffering from the disease. Additionally, loss of independence in advanced stages of Alzheimer’s disease can lead to additional burden on family caregivers and/or expenses related to the need for full-time care in a nursing facility.
Value assessment has to be part of these conversations. As we discuss reform of national healthcare programs, we must also modernize our approach to care valuation. For example, many patients currently face high out-of-pocket (OOP) costs in the Medicare Part D program due to the absence of a limit of patient liability. The impact of these costs is exacerbated by the fact that many older adults live on fixed incomes. The Alliance is working through our Project LOOP initiative to advance reforms, including an annual cap on OOP expenditures and a smoothing mechanism to allow patients to pay for drug costs over a plan year. However, Congress should not pair Part D reform with schemes that reference QALY-based pricing from other nations.
What do you see as the biggest opportunity to join IVI as members and partners?
For the Alliance, it was important to partner with IVI to show that there is a better way – alternatives to current value assessment models exist and can be patient-centered! As an IVI member, we look forward to carrying the vital message that additional investments are needed to advance patient-centered research.
Many thanks to Mr. Ward for taking the time for this conversation and for the Alliance’s ongoing commitment to advancing the science of value assessment.