A brand new drug comes available on the market. Is the well being profit price the fee? What’s it’s worth? Worth evaluation frameworks are one solution to reply this query. Worth frameworks take the proof of the remedies advantages, danger and price and output some notion of the therapy’s worth. Ideally, if anybody utilized a given worth framework, they might get the identical or a minimum of comparable solutions concerning the remedies true worth. However is that the case in follow?
A paper by Karas et al. (2021) goals to supply the reply. The authors performed a retrospective, observational research at a single well being system. They look at how three people–a fourth-year pharmacy pupil, a drug data resident, and a drug data pharmacist–utilized the worth evaluation frameworks to the identical drug. The worth evaluation frameworks evaluated had been three oncology-specific worth frameworks (i.e., ASCO, ESMO, and NCCN) and two non-oncology (the ACC/AHA framework and the ICER calculation). The important thing statistical measure of curiosity was the intraclass correlation coefficient (ICC), which was used to measure inter-rater reliability. Utilizing this strategy as utilized to 94 drugs, the authors discovered that:
…[t]he VAFs [value assessment frameworks] with the very best ICCs between all three raters had been NCCN (0.635; 95% CI = 0.387-0.823) and ASCO (0.634; 95% CI = 0.370-0.832), each indicating reasonable inter-rater reliability. The VAFs with the bottom ICCs had been ESMO (0.368; 95% CI = 0.126-0.611) and ICER (0.159; 95% = CI −0.018-0.365), with ICCs akin to poor reliability.
This doesn’t essentially imply that NCCN and ASCO are ‘higher’ as a quite simple worth framework could also be straightforward to make use of and have ICC, however it could miss many worth components. The incremental price effectiveness ratio (ICER) strategy has the benefit of being very flexibility to completely different illness areas, however–probably partially as a result of this flexibility–it may be utilized in a different way by completely different people.
- Karas BL, Picone MF, Werner S, Holsopple M. Verifying the worth of present frameworks for formulary overview at a big tutorial well being system: assessing inter-rater reliability. Journal of Managed Care & Specialty Pharmacy. 2021 Apr;27(4):488-96.