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Value-Based Health Care Meets Cost-Effectiveness Analysis

This recent abstract helps reduce confusion about the various terms that are used to determine the value of care.


I tend to see both terms in research articles: value-based health care and cost-effective analysis. Typically the cost-effective analysis articles also reference quality-adjusted life year (QALY). Both terms tend to have quite a bit of mathematics involved in determining either value or cost-effectiveness.

It seems value-based health care is more focused on the patient - capturing not only outcomes, but also the patient's experience and the the patient's perspective about the services provided. Obviously mathematics is involved - typically more in the area of determining payment for services. 

Cost-effective analysis often times feels "cold" to me. It focuses on the numbers. There is a cut off dollar amount that indicates the "value" to the intervention. From the studies that I have looked at, it doesn't seem to pull in outcomes data. It uses a utopia figure of one year of perfect health. So it looks at alive versus dead and the quality of life if alive. The quality of life aspect just seems arbitrary and maybe even kind of imaginary to me. From my perspective, cost-effective analysis seems more complex to understand and is less concrete than value-based health care. 

I pulled this abstract to share because we may begin to see a merging of sorts between the two terms as various quality payment models are proposed.

You'll find the abstract to the recent study below.

Value-Based Health Care Meets Cost-Effectiveness Analysis.



Value-based health care (VBHC) has recently emerged as a prominent movement within health care. Value-based health care focuses on maximizing outcomes achieved per dollar spent. As such, it bears many similarities to a well-established method, cost-effectiveness analysis (CEA), which provides a framework for comparing the relative value of different diagnostic or treatment interventions. Both approaches address "bang for the health care buck," but although they overlap in many ways, VBHC and CEA differ with regard to their main applications, their perspective, and the types of costs and outcomes they consider. For example, CEA generally considers costs and benefits from the societal or health care sector perspectives, whereas VBHC is intended to adopt the patient perspective. As such, CEA is intended to inform coverage decisions at a group or population level and VBHC is intended to be implemented at the level of clinician-patient interactions. Meanwhile, value-based payment has emerged as a visible component of VBHC and is gaining a foothold in the United States in various forms, particularly bundled payments and accountable care organizations, in an effort to reward high-value care and disincentivize low-value care. Differences aside, as the worlds of VBHC and CEA begin to intersect, each discipline can learn from the other.

 2018 Sep 4;169(5):329-332. doi: 10.7326/M18-0342. Epub 2018 Aug 7.

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