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.
Katie Koziara
Katie Koziara is Senior Director of public affairs at PhRMA focusing on the organization’s executive visibility work and media relations strategy. She previously ran the social media strategy for a D.C.-based non-profit working on federal management and leadership issues. Katie earned her B.A. in Public Policy from the University of Michigan’s Ford School and is currently earning her M.A. in Fiction Writing from Johns Hopkins University.
Katie Koziara
Recent events highlight progress on health equity
ICYMI: PhRMA’s 4th Annual Pathways to Success: Virtual STEM Career Expo
Hispanic Heritage Month: Fighting for Hispanic patients
PhRMA awards grants to 2024 Annual Pathways to Success: Virtual STEM Career Expo Partners
How government price setting fails to address systemic health care inequities
Women’s Health Month: A conversation with Sage
Championing cancer equity: Our drive for healthier AANHPI communities
New analysis: Accelerated approval pathway is changing lives in underserved communities
New analysis: Flawed assessments of a medicine’s value jeopardize patient access
PhRMA provides grant funding to support the Morehouse School of Medicine Satcher Health Leadership Institute’s Health Equity Tra
New social determinants of health simulation explores structural barriers patients face accessing and affording medicines
PhRMA awards grants to 2023 Annual Pathways to Success Graduate Summit Partners
Between hope and despair: Improving cancer outcomes
PhRMA awards grant to Emerson Diversity Health Foundation
PhRMA Otorga Beca a la “Emerson Diversity Health Foundation”
Using traditional HTAs to determine coverage threatens patient access to medicine
Traditional HTAs keep diverse patients out of the conversation
How HTA-based price controls could worsen health outcomes and health disparities
Value assessment should include all aspects of value that matter to patients
You won’t fix what you don’t value: Two reasons why traditional cost-effective analyses can perpetuate health inequities
Potential gene therapies bring hope to patients with sickle cell disease
PhRMA presents research at ISPOR 2022
Stephanie Dyson of BMS on reducing health disparities
Sharing rebates can save Americans with diabetes 500 each year and improve adherence
Announcing CAREs Grant Round 4
Announcing CAREs Grant Round 4
Guest Series: PhRMA talks racial and health equity with Lauren Powell, VP US Health Equity and Community Wellness, Takeda
PhRMA awards $75,000 to fund initiatives to reduce health inequities
Watch: Building trust and enhancing clinical trial diversity
More than 800 medicines are in development for diseases that disproportionately affect racial and ethnic communities
PhRMA hosts first stakeholder workshop on clinical trial diversity
Creating a new patient risk paradigm in American health care
PhRMA CAREs Grant request for proposals: Addressing inequities in access to COVID-19 testing, therapeutics and vaccines
PhRMA member companies share how they are improving clinical trial diversity
Guest post: PhRMA talks racial and health equity with Stephanie Dyson, Head of Office at Biogen
Paper finds gaps in health data are a barrier to health equity
New research shows hotspots of inequity relate to increased COVID-19 hospitalizations
Increasing diversity at investigator sites could increase minority participation in clinical trials
Report highlights biopharmaceutical industry’s commitment to D&I
Strengthening a culture dedicated to patients and equity: A conversation with Percival Barretto-Ko, President of Astellas US
PhRMA CAREs Grant request for proposals: Addressing racial disparities in medication utilization and adherence
Committing to diversity, equity and inclusion: A call to action for clinical trials
Just released: PhRMA members’ new clinical trial diversity principles
ICYMI: Addressing health inequities: Biopharmaceutical companies are rising to the occasion
Guest Post: Honoring Hispanic Heritage Month by taking action on health equity
Sharing rebates can improve access to medicines and increase health equity
PhRMA will continue to advocate for equity within our industry
Three ways the pharmaceutical industry can positively impact health equity
Guest Post: Amgen Foundation stands for equal opportunities in STEM learning
Systemic racism is as real as any disease, and our industry is not immune
Guest Post: Pride started with protest: Combatting the dual pandemics of COVID-19 and racism this Pride Month
PhRMA awards $100,000 to fund projects that address health inequalities
Observing National Minority Health Month in the age of COVID-19
Traditional HTA methods treat everyone like the “average” patient
Health Equity
Value Assessment
Traditional HTA methods treat everyone like the “average” patient
Traditional HTA methods treat everyone like the “average” patient