The third section of our Special Task Force report identifies and defines a series
of elements that warrant consideration in value assessments of medical technologies.
We aim to broaden the view of what constitutes value in health care and to spur new
research on incorporating additional elements of value into cost-effectiveness analysis
(CEA). Twelve potential elements of value are considered. Four of them-quality-adjusted
life-years, net costs, productivity, and adherence-improving factors-are conventionally
included or considered in value assessments. Eight others, which would be more novel
in economic assessments, are defined and discussed: reduction in uncertainty, fear
of contagion, insurance value, severity of disease, value of hope, real option value,
equity, and scientific spillovers. Most of these are theoretically well understood
and available for inclusion in value assessments. The two exceptions are equity and
scientific spillover effects, which require more theoretical development and consensus.
A number of regulatory authorities around the globe have shown interest in some of
these novel elements. Augmenting CEA to consider these additional elements would result
in a more comprehensive CEA in line with the "impact inventory" of the Second Panel
on Cost-Effectiveness in Health and Medicine. Possible approaches for valuation and
inclusion of these elements include integrating them as part of a net monetary benefit
calculation, including elements as attributes in health state descriptions, or using
them as criteria in a multicriteria decision analysis. Further research is needed
on how best to measure and include them in decision making.