Equity considerations in US value assessment: Opportunities ahead

Increasingly the US healthcare system is acknowledging that there is an need to consider and address health disparities and healthcare inequality. A logical place to start is with payers and the tools they are using to make coverage decisions. Xcenda reviewed reports from several value assessment frameworks to determine if they considered health disparities in their framework. We looked at Institute for Clinical and Economic Review (ICER), Memorial Sloan Kettering Cancer Center (MSKCC) Drug Abacus, American Society of Clinical Oncology (ASCO) Value Framework, National Comprehensive Cancer Network (NCCN) Evidence Blocks, Innovation and Value Initiative (IVI) Value Model, and the Patient-Centered Outcomes Research Institute (PCORI).

The results show that there is a lot of room for improvement. For example, while ICER’s mission reflects an awareness of the importance of addressing health and healthcare disparities, when looking at therapeutic area reports that likely should have addressed health disparities – they weren’t there. Only 2 of the 6 ICER reports that were reviewed addressed health disparities in a meaningful way, and only 1 ICER report included a quantitative analysis incorporating racial disparities. With the exception of the IVI Value Model, other US-based VAFs also do not explicitly incorporate health or healthcare disparities in their respective frameworks, though 2 organizations (ASCO and NCCN) have recently implemented other initiatives centered around addressing disparities in cancer care. It is incumbent upon all relevant players in the healthcare ecosystem to keep moving in the direction of better; to ensure all patients benefit from equitable levels of health and healthcare.

Read the issue brief below for lessons learned and recommendations to improve value assessment in the US.