Measuring Value in Health Care: A Comparative Analysis of Value-based Frameworks

Purpose: This paper presents a comparative analysis of value-based frameworks (VBFs) developed in the United States and Europe for both drugs and medical devices. Methods: The authors relied on a comprehensive literature review to identify relevant dimensions of analysis and available VBFs. Compared to previous studies on this topic, this study focused on the roles and strategic objectives of different institutions and organizations currently orchestrating the debate and development of VBFs and value-based initiatives. Findings: Among several projects and initiatives aimed at measuring value in health care, the study identified and analyzed in detail 7 VBFs. Different frameworks not only reflect different conceptions of value, but also different strategic objectives for which value needs to be measured: influencing clinical decision making, informing health care policies, affecting reimbursement, and pricing mechanisms or driving industry developments. Ultimately, all of these objectives represent different levers for fostering value-based treatment choices, but their different routes imply the assignment of key responsibilities to different actors within health care: medical professionals, patients, policymakers, payers, and medical technology and pharmaceutical companies. Implications: The proliferation of frameworks used for measuring the value of different health care objects and processes seems certainly a worthy exercise, but a real paradigm shift toward value-based care could only happen if these tools will be systematically used in practice and if all of these levers are played together, with joint actions and shared awareness of the key stakeholders' groups. (C) 2019 Elsevier Inc. All rights reserved.