As healthcare costs in the United States have continued to grow, there has been an increasing desire to move towards “value-based” care in which patients and payers would be paying for the “value” of the treatment patients receive. This idea has been gaining particular momentum as policymakers look for strategies to curtail spending on pharmaceuticals. While there is merit in paying for services and treatments that work and eliminating wasteful spending, it is important to step back and consider to whom “value” is being provided. As the ultimate beneficiary, we would advocate that the measure of “value” in a healthcare setting should focus on value to the patient, but currently, we are concerned that the trend is to look towards “value” to the payer by prioritizing reduced cost over care outcomes for patients in the form of cost- effectiveness analyses. For this reason, there is debate within health care stakeholders as to whether value assessments are necessary or useful. The flaws of cost-effectiveness analyses that are currently in use become particularly pronounced when evaluating treatments for population and patient cohorts that, historically, have not been included in the research, and for diseases that have not received equitable consideration in research or in diagnosis and treatment paradigms. To a significant degree, these flaws become manifest in communities and patients of color who invest in the system through taxes, insurance premiums and out-of-pocket costs, populations whose numbers are rapidly increasing the diversity of the American general population.
This issue brief will examine ways that current methods of cost-effectiveness analysis and value assessment fail to reflect true value to patients and will offer recommendation regarding methods to address this inequity.