‘Value’ in health care – who decides?

By European Alliance for Personalised Medicine (EAPM) Executive Director Denis Horgan 

The differing ideas about what constitutes ‘value’ in modern medicine is a hot topic for debate in Europe and beyond.

How do we define it? How do we measure a human life – or quality of life – against the cost of a treatment? Do we judge the individual’s contribution, fiscally and otherwise, to society and weigh it against a price? What about the moral issues involved in such judgments? And who would want to make them?

Consider an equation such as this  – ‘Mr A will pay x in taxes if we treat him, he survives and he then goes back to work. But the treatment costs y. Let’s do the maths…’

Most of us would find that shocking, unfair and inhumane. Yet it happens in a broad sense.

Unfortunately, with an aging population of 500 million citizens, health care in the EU has never been more expensive. People are living longer and will, in most cases, be treated for not just one but several ailments during their lifetime. It’s a dilemma, and it won’t go away.

To understand ‘value’ one must first, of course, understand a treatment, plus any other treatment options, and consider what it (or they) can provide.

Patients, when they understand their options, will have their own views on what constitutes value, depending on their circumstances  – “Will I get better? Will I live longer? Will my quality of life improve? What are the side effects?”. `

Payers, not surprisingly, when they weigh, as they do, benefits against cost and other considerations, may take a different approach.

Meanwhile, manufacturers and innovators must operate within limits of ‘value’ that are as yet unclear.

There is a solid argument that value should always be defined in respect of the customer, Value in health care depends on results and outcomes – vital to the patient – regardless of the volume of services delivered, yet the value is always going to be seen as relative to cost.

So, are expensive medicines and treatments ‘worth it’? Let us take two specific examples. First, new drugs to treat the hepatitis C virus (HCV) may beat the epidemic. But their cost is high and beyond many patients.

The World Health Organization tells us that 350,000 people die each year from the 150 million chronically infected with HCV and the new direct-acting antivirals could halt the global spread of infection. So, if health-care systems supply the drugs, is that value? You decide…

Second, up-to-the-minute cancer treatments can now treat some of the most severe or rarest diseases known to man. Over the past two-and-a-half decades, cancer patient life expectancy has risen by some three years, with four-fifths of that figure directly down to new treatments and medicines.

These drugs and treatments are expensive. But are they worth it? Again, you decide…

Yes, money is a huge factor. Yet Europe should make no mistake about the correlation between wealth and health. Studies – at least one conducted on behalf of the EU executive itself - have repeatedly shown that the benefits of improved public health extend beyond simply reducing health-care costs. The facts are that better health makes a positive contribution to the productivity of citizens.

Meanwhile, less hospital beds are used up, people tend to work longer before retiring when they are healthier, citizens are more productive when healthy and often work longer hours, and there are less sick days taken. That’s certainly one idea of ‘value’.

Personalised health care is a rapidly growing field that aims to provide the right treatment to the right patient at the right time. The European Alliance for Personalised Medicine (EAPM) has worked with its membership to engage patients, payers, policymakers, academia, and industry to examine various approaches to value assessment.

A 25 February workshop in the value of, in this case, companion diagnostics – will showcase the different views – including those from an EAPM cross-stakeholder survey – with the objective of hosting a critical discussion.

Europe’s – and the world’s – ongoing debate on the meaning of ‘value’ in health care needs to be concluded soon, for the benefit of this generation of patients and the many more that will follow.

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