Concerns about the cost of health care have led to calls for the use of health technology assessments or HTAs by the federal government. This would allow government agencies to make important decisions about patient access to health care based on their determination of the value of new tests and treatments. It’s important to consider the best available information and evidence when making health care decisions. However, traditional HTA models often rely on flawed approaches that ignore patient differences and reinforce health disparities, which can ultimately lead to limited access to lifesaving treatments.
The Inflation Reduction Act underscores the need for better approaches to HTA methods and decision-making tools. Although HTA currently does not play a central role in Medicare, CMS now has unprecedented new power to make judgments about the relative clinical value of new treatments.
In this series, we’ll explore some of the flaws in current HTA methods that reaffirm concerns with government use of HTAs to make decisions about coverage or payment for new medicines. In addition to offering ideas to improve HTAs in the market, we also examine how relying on traditional HTAs can:
- Ignore differences in diverse populations
- Limit access to beneficial treatment options
- Reinforce — rather than reduce — health disparities
There is no “average” patient — each individual patient comes with his or her own health history, family background and personal experiences that shape their viewpoints and health preferences. Yet traditional health technology assessments, or HTAs, use the idea of an “average” patient to make value assessments of medicines that often don’t align with what patients actually value or the diversity of the U.S. population.
What’s worse, allowing the government to use these assessments to decide what a treatment is worth and which medicines patients have access to could perpetuate health disparities by ignoring the distinct needs of populations and making decisions based on these non-existent “average” patients. Patients of different demographic or socioeconomic factors are often affected differently by the same treatment due to factors such as age, sex, comorbidities and access to care.
Because these unique patient differences are not accounted for in arbitrary averages, HTAs can fail to recognize underlying disparities and when treatments may be valued more within certain communities:
- HTA rarely accounts for patient differences, especially among racial and ethnic minority populations. According to Tufts Medical Center, fewer than 5% of HTAs report results by race or ethnicity.
- A vaccine for pneumococcal pneumonia was found to be nearly twice as valuable for Black patients relative to the average patient. If coverage were determined based on value to an average patient, Black patients could be denied a treatment that is high value for them.
- Given the underlying inequities in life expectancy differences across racial groups, HTA suggests the value of a life-saving treatment will benefit Black patients up to 10% less than white patients.
We can build a more resilient, affordable and equitable health care system without devaluing treatments among the people who rely on them. To do so, we need to recognize patient differences and reduce health disparities rather than reinforcing them.
To learn more about PhRMA’s efforts to improve care affordability, value assessment frameworks and health equity, visit phrma.org/policy-issues/value-assessment.