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HTA Stakeholders Call for More Efforts into the Further Development and Testing of Social Cost Value Analysis as an Alternative Approach to Health Economic Evaluation

by Angelika Oberhof

A new position paper authored by an international group of health economists, and experts in clinical pharmacology, Health Technology Assessment (HTA), and medical ethics calls for more efforts into the further development and testing of alternative health economic evaluation paradigms, notably social cost value analysis (SCVA).

According to the conventional logic of cost effectiveness (analysis, CEA), health care interventions are prioritized according to their incremental cost effectiveness ratios (ICERs). Lower cost per quality-adjusted life year (QALY) gained is assumed to translate into higher social desirability of coverage. Following this paradigm, relatively low cost interventions such as sildenafil for erectile dysfunction in elderly diabetics or tattoo removals might be given higher priority for funding than many clinically effective cancer treatments and interventions for rare disorders. This apparent anomaly stimulated the authors to focus on the case of drugs for ultra-rare disorders (URDs) to explore some of the underlying issues.

Based on an analysis of the disparate literature, the authors agreed on the need for an alternative paradigm for the economic evaluation of health care interventions. They concluded that the currently prevailing paradigm fails to capture the full social value of many interventions. Therefore, more systematic research should be devoted to the empirical measurement of social preferences and to the development of a new evaluation paradigm. Health economists should prioritize the testing and evaluation of economic methods such as social cost value analysis, rather than further rationalize and consolidate the conventional model.