Value-Based Medicine Analyses
Evidence-based medicine is a long-standing phrase well-known to most of us. It has helped us focus on clinical trial results and usage of the data in providing the very best care to patients.
With the rising costs of healthcare the evolution from evidence-based medicine to Value-Based Medicine® is one of necessity. It forces us to define value and fine-tune our ability to measure quality-of-life improvement afforded by medical interventions. The clinical trials routinely delineate results and efficacy which, by themselves, tell us part of the story. However, Value-Based Medicine® allows for comparison among dissimilar trials and puts new science into practice.
Value-Based Medicine is the practice of medicine based upon the utilization of medical interventions, pharmaceuticals and devices that deliver value by improving the length of life and/or increasing the quality-of-life experienced by patients.
Utility analysis is a methodology that allows quantification of quality-of-life. It therefore can quantify the improvement obtained for a given medical intervention. Not only are efficacy data used, but quality-of-life changes due to adverse effects are included in the analyses. Once the quality-of-life of given health states are identified, those data can be combined with the evidence of the appropriate clinical trials in a decision analysis model.
Utilities used at the Center have anchors of 1.00 (normal health permanently) to 0.00 (death). Because the calculation of utilities typically requires patients to theoretically trade something of value (time of life, a decreased chance of death, money, and so forth) to obtain a better health state, or prefer not to trade and remain in the same health state, utilities are often referred to as patient preferences.
Standardization of methodology in Value-Based Medicine® analyses is critical. The Center uses patient preferences, or utilities, to assess patient value (improvement in quality-of-life and/or length of life) delivered by medical treatments. Following the quantification of the patient value of medical interventions, cost considerations can and should be considered with interventions providing similar value outcomes. Relevant costs are amalgamated into the model to provide cost-effectiveness analyses. Cost-effectiveness analysis utilizes a standardized approach to delineate relevant costs of care.
Evidence-based to Value-based Medicine is a text designed to introduce the concepts of Value-Based Medicine® and its application across all of medicine. Not only do physicians and other providers need to be able to document interventional value to patients within their field, they must be able to show this value to patients as compared to any other medical specialties.