Discussion of presentation by Rachel BakerPerspectives, priorities and pluralityEliciting societal values and the relative value of life extension at the end of life

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This document summarizes Koonal Shah's discussion of a presentation by Rachel Baker on eliciting societal values and preferences regarding life extension at the end of life. Shah notes the importance of Baker's work in combining qualitative and quantitative methods to allow unexpected viewpoints to emerge on this policy issue. However, Shah also discusses limitations such as the study's non-representative sampling and questions whether the analysis allows consensus or only plurality. Overall, the discussion examines the strengths and limitations of Baker's approach to understanding heterogeneous public perspectives on prioritizing end of life health gains.

Koonal Shah
London Health Economics Group
OHE • 17 November 2016
Discussion of presentation by Rachel Baker
Perspectives, priorities and plurality
Eliciting societal values and the relative value of life
extension at the end of life

LHEG – Shah discussion of Baker presentation
17/11/16 2
• Relevant to a current policy issue
• Addresses issue of preference heterogeneity
• Addresses other gaps in the literature
Why this work is important

LHEG – Shah discussion of Baker presentation
17/11/16 3
• Combines qualitative data collection with
quantitative data analysis
• Allows unexpected viewpoints to emerge
• Rigorous approach to generating statement set
• Q study examines strength of preference at the
individual level
• Follow-on study (Q2S) examines the extent of
support for the various viewpoints at the
sample level
Strengths of the approach

LHEG – Shah discussion of Baker presentation
17/11/16 4
• Purposive sampling – ‘data rich’ but
unrepresentative
• To what extent are the factors / perspectives
determined by the choice of statements?
• Would authors’ methods of analysis have
allowed a consensus viewpoint to have
emerged, or is plurality inevitable?
Limitations of / questions about
the approach

LHEG – Shah discussion of Baker presentation
17/11/16 5
Review of the literature
Research question:
Do members of the general public wish to
place greater weight on a unit of health
gain for end of life patients than on that for
other types of patients?
Short version:
Is there support for an ‘end of life
premium’?

LHEG – Shah discussion of Baker presentation
17/11/16 6
Inclusion criteria
1. Publication: Article must be published in English in a peer-reviewed
source.
2. Empirical data: Article must review, present or analyse empirical data.
3. Priority-setting context: Article must relate to a health care priority-
setting or resource allocation context. Articles reporting preferences
from an individual or ‘own health’ perspective (rather than a social
decision maker perspective) can be included as long as they clearly
seek to inform health care priority-setting policies.
4. Stated preference data: Article must report preferences that were
elicited in a hypothetical, stated context using a choice-based approach
involving trade-offs.
5. End of life: Article must inform the topic of placing greater weight on a
unit of health gain for end of life patients (i.e. patients with short life
expectancy) than on that for other types of patients.
6. Original research: Article must present original research and must not
be solely a review of the literature.

LHEG – Shah discussion of Baker presentation
17/11/16 7
Data extraction challenges!

LHEG – Shah discussion of Baker presentation
17/11/16 8
Data extraction challenges!

LHEG – Shah discussion of Baker presentation
17/11/16 9
Perspective and indifference
• Individual or social perspective?
• Is this an indifference option?

LHEG – Shah discussion of Baker presentation
17/11/16 10
• Study highlights ‘plurality’ of views – also
observed in other studies
• Perhaps this explains why the evidence in my
review is mixed
• Majoritarian decision rules are common in
policy making (but criticised)
• Normative basis for specifying a single measure
of average or overall preference in social
choices is unclear
Preference heterogeneity

LHEG – Shah discussion of Baker presentation
17/11/16 11
Thank you for your attention
For further information, please contact Koonal Shah at kshah@ohe.org
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This document summarizes a presentation given by Rachel Baker on eliciting societal values and perspectives on the relative value of life extension at the end of life. Baker discusses a study using Q methodology to identify viewpoints on this issue among experts and the public. The study identified three perspectives: valuing wider benefits and quality of life (Factor 3), a population perspective focusing on value for money (Factor 1), and valuing life extension and patient choice (Factor 2). The research then used Q survey methods to quantify how common these viewpoints are in the general UK population, finding pluralism with Factors 1 and 2 more dominant.

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Office of Health Economics

Koonal presented as part of an organised session on ‘moving beyond conventional economic approaches in palliative and end of life care’. He summarised the empirical evidence on the extent of pubic support for an end of life premium, before discussing some novel approaches that have been used in recent studies. His presentation was discussed by Helen Mason of Glasgow Caledonian University. Author(s) and affiliation(s): Koonal Shah, Office of Health Economics Event: iHEA Congress Date: 17/07/2019 Location: Basel, Switzerland

Assessing the Life-Cycle Value Added of Second Generation Antipsychotics in S...

Office of Health Economics

This research presented in a poster at HTAi 2019, Cologne (Germany) by a team of OHE and IHE researchers, estimates the value added by second generation antipsychotics over their life-cycle in the UK and Sweden. It concludes that considering the entire life-cycle, the value added by SGAs to the system is higher than the expected value estimated at launch. P&R decisions should consider how to measure, capture and take into account the value added by medicines over the long-run. Author(s) and affiliation(s): Mikel Berdud (Office of Health Economics, London), Niklas Wallin-Bernhardsson (Institute for Health Economics, Stockholm), Bernarda Zamora (Office of Health Economics, London), Peter Lindgren (Institute for Health Economics, Stockholm), Adrian Towse (Office of Health Economics, London) Event: HTAi 2019 Annual Meeting Date: 18/06/2019 Location: Cologne, Germany

HTA and payment mechanisms for new drugs to tackle AMR

Office of Health Economics

The document discusses challenges with developing new antibiotics and incentivizing research and development. It notes that existing health technology assessment models do not fully capture the public health value of new antibiotics. It recommends that countries modify their HTA and contracting approaches to better recognize individual and societal benefits, such as preventing transmission and avoiding outbreaks. The document also recommends exploring pilots of delinked payment models from England and Sweden and applying modeling techniques used for vaccines to the assessment of antibiotics.

Assessing the Life-cycle Value Added of Second-Generation Antipsychotics in S...

Office of Health Economics

This study aims to guide access decisions and drive the discussion on access and price, through recognition of the dynamic nature of value added by pharmaceutical innovation over the long-run. The analysis of the life-cycle value of risperidone estimates the value generated in the UK and Sweden. Results show that health systems were able to appropriate most of the life-cycle value generated, and this is larger than estimated at launch. Author(s) and affiliation(s): Mikel Berdud(1), Niklas Wallin-Bernhardsson(2), Bernarda Zamora(1), Peter Lindgren(2), and Adrian Towse(1) (1) Office of Health Economics (2) The Swedish Institute for. Health Economics Event: XXXIX JORNADAS DE ECONOMÍA DE LA SALUD Date: 12/06/2019 Location: Albacete, Spain

Pay for Performance for Specialised Care in England

Office of Health Economics

This document summarizes a presentation on pay-for-performance (P4P) programs in the English National Health Service (NHS), specifically the PSS-CQUIN schemes for specialised services. PSS-CQUIN uses incentive payments to encourage quality improvement and value for money in specialised care areas like cancer treatment and mental health. The schemes link a portion of provider funding to performance indicators. While PSS-CQUIN aims to improve care quality, its complexity and lack of evidence linking indicators to outcomes are areas for improvement. An ongoing evaluation will assess PSS-CQUIN's effectiveness and cost-effectiveness to inform future contract designs.

Real option value drugs: is it really an option?

Office of Health Economics

In this session, Meng Li sets out estimates of real option value for drugs arguing that option value matters and can be calculated. Adrian Towse sets out likely payer concerns about incorporating real option value into decision making. Meng Li responds to these concerns. Jens Grueger sets out how industry considers investment opportunities, arguing that if patients (and society) have preferences these need to be reflected in P&R decisions. Author(s) and affiliation(s): Meng Li, Postdoctoral Research Fellow, Leonard D Schaeffer Center, University of Southern California, Los Angeles, CA, USA. Adrian Towse, Emeritus Director, Office of Health Economics, London, UK Jens Grueger, formerly Head of Global Access, Senior Vice President at F. Hoffmann-La Roche Event: ISPOR 2019 Location: New Orleans, USA Date: 21/05/2019

MCDA OR WEIGHTED CEA BASED ON THE QALY? WHICH IS THE FUTURE FOR HTA DECISION ...

Office of Health Economics

In this ISPOR session Chuck Phelps and Adrian Towse debated the case for and against using MCDA to support HTA decision making, as compared to weighting or augmenting a QALY based ICER approach. Chuck Phelps argued for use of MCDA, Adrian Towse for weighting the QALY. Nancy Devlin set the scene and moderated. Author(s) and affiliation(s): Nancy Devlin, Director, Centre for Health Policy, University of Melbourne, Australia Adrian Towse, Emeritus Director, Office of Health Economics, London, UK Chuck Phelps, University of Rochester, Rochester, NY USA Event: ISPOR 2019 Location: New Orleans, USA Date: 21/05/2019

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Discussion of presentation by Rachel BakerPerspectives, priorities and pluralityEliciting societal values and the relative value of life extension at the end of life

1. Koonal Shah London Health Economics Group OHE • 17 November 2016 Discussion of presentation by Rachel Baker Perspectives, priorities and plurality Eliciting societal values and the relative value of life extension at the end of life

2. LHEG – Shah discussion of Baker presentation 17/11/16 2 • Relevant to a current policy issue • Addresses issue of preference heterogeneity • Addresses other gaps in the literature Why this work is important

3. LHEG – Shah discussion of Baker presentation 17/11/16 3 • Combines qualitative data collection with quantitative data analysis • Allows unexpected viewpoints to emerge • Rigorous approach to generating statement set • Q study examines strength of preference at the individual level • Follow-on study (Q2S) examines the extent of support for the various viewpoints at the sample level Strengths of the approach

4. LHEG – Shah discussion of Baker presentation 17/11/16 4 • Purposive sampling – ‘data rich’ but unrepresentative • To what extent are the factors / perspectives determined by the choice of statements? • Would authors’ methods of analysis have allowed a consensus viewpoint to have emerged, or is plurality inevitable? Limitations of / questions about the approach

5. LHEG – Shah discussion of Baker presentation 17/11/16 5 Review of the literature Research question: Do members of the general public wish to place greater weight on a unit of health gain for end of life patients than on that for other types of patients? Short version: Is there support for an ‘end of life premium’?

6. LHEG – Shah discussion of Baker presentation 17/11/16 6 Inclusion criteria 1. Publication: Article must be published in English in a peer-reviewed source. 2. Empirical data: Article must review, present or analyse empirical data. 3. Priority-setting context: Article must relate to a health care priority- setting or resource allocation context. Articles reporting preferences from an individual or ‘own health’ perspective (rather than a social decision maker perspective) can be included as long as they clearly seek to inform health care priority-setting policies. 4. Stated preference data: Article must report preferences that were elicited in a hypothetical, stated context using a choice-based approach involving trade-offs. 5. End of life: Article must inform the topic of placing greater weight on a unit of health gain for end of life patients (i.e. patients with short life expectancy) than on that for other types of patients. 6. Original research: Article must present original research and must not be solely a review of the literature.

7. LHEG – Shah discussion of Baker presentation 17/11/16 7 Data extraction challenges!

8. LHEG – Shah discussion of Baker presentation 17/11/16 8 Data extraction challenges!

9. LHEG – Shah discussion of Baker presentation 17/11/16 9 Perspective and indifference • Individual or social perspective? • Is this an indifference option?

10. LHEG – Shah discussion of Baker presentation 17/11/16 10 • Study highlights ‘plurality’ of views – also observed in other studies • Perhaps this explains why the evidence in my review is mixed • Majoritarian decision rules are common in policy making (but criticised) • Normative basis for specifying a single measure of average or overall preference in social choices is unclear Preference heterogeneity

11. LHEG – Shah discussion of Baker presentation 17/11/16 11 Thank you for your attention For further information, please contact Koonal Shah at kshah@ohe.org To keep up with the latest news and research, subscribe to our blog, OHE News Follow us on Twitter @OHENews, LinkedIn and SlideShare Office of Health Economics (OHE) Southside, 7th Floor 105 Victoria Street London SW1E 6QT United Kingdom +44 20 7747 8850 www.ohe.org OHE’s publications may be downloaded free of charge from our website.

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