title: The Value of Medicines: A Crucial but Vague Concept.
abstract: Health Technology Assessment is increasingly used to evaluate the value of healthcare products and to prioritize resources; however, defining exactly what value is and how it should be measured remains a challenge. In this article, we report the results of a literature review, focusing on nine European countries, with the aim of investigating how value is defined from the perspective of different stakeholders, how definitions of value are used, and how value is incorporated into decision making. Only three articles were identified that presented definitions of value, and there was no single shared definition of value in healthcare, which appears to be a highly subjective concept. The majority of the countries investigated combine clinical assessment with economic evaluation to make reimbursement recommendations; the quality-adjusted life-year is the most commonly used measure of value but does not capture broader aspects of value that may be important to patients and healthcare systems. We describe the use of value-based pricing and multi-criteria decision analysis, two approaches to the incorporation of broader aspects of value into decision making. Overall, we have identified considerable variation in how a product's value is defined by different stakeholders. Although a universal understanding of value in healthcare is important, it is clear that current definitions are insufficient, potentially leading to inconsistent reimbursement decisions. Ultimately, the establishment of clearer policies for defining and measuring value in healthcare is needed, and is likely to lead to improvements in the consistency of decision making.
authors.affiliation: Department of Economics, University of La Rioja, Logroño, Spain. fernando.antonanzas@unirioja.es.
authors.forename: Fernando
authors.identifier: 0000-0001-6122-9130
authors.initials: F
authors.lastname: Antoñanzas
authors.affiliation: College of Pharmacy, University of Florida, Gainesville, FL, USA.|University of Groningen, Groningen, The Netherlands.
authors.forename: Robert
authors.initials: R
authors.lastname: Terkola
authors.affiliation: Unit of Pharmacotherapy, Epidemiology and Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands.|Institute of Science in Healthy Aging and healthcaRE (SHARE), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.|Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Maarten
authors.initials: M
authors.lastname: Postma
mesh_terms: D020811:Biomedical Technology / Q000191:economics*; D003365:Costs and Cost Analysis; D003657:Decision Making; D003661:Decision Support Techniques; D003695:Delivery of Health Care / Q000191:economics*; D005060:Europe; D006801:Humans; D004364:Pharmaceutical Preparations / Q000191:economics; D019057:Quality-Adjusted Life Years; D012051:Reimbursement Mechanisms; D013673:Technology Assessment, Biomedical / Q000379:methods*
chemical_list: D004364:Pharmaceutical Preparations