Open-Source Model Devised to Value Medical Technologies

(National Institutes of Health)

8 November 2017. An initiative joining most major health care stakeholders is developing models to calculate the value of medical treatments, with a process described as open and transparent. The Innovation and Value Initiative, based in Los Angeles, released today the first product from its Open-Source Value Project, a tool to measure the value of treatments for rheumatoid arthritis.

The Open-Source Value Project seeks to provide a better understanding of the value of health care products and technologies for people and companies in the industry, as well as individuals, institutions, and enterprises directly affected by health care. But as important as the tools being developed, say the group’s leaders, is the process creating the tools, which they say needs to engage stakeholders, bring forward their perspectives, and gain consensus. Those perspectives include patients, payers — e.g., insurance companies, Medicare — policy makers, and providers of health care products and services.

The Open-Source Value Project’s process develops separate economic models to compute the costs of treatments for individual diseases. Each disease model is released for comments and recommendations across the health care industries, where they’re reviewed by an expert panel that prepares a set of recommendations. Those recommendations then are included in a revised model, with all decisions documented. The models are expected to be living, dynamic documents that can be expanded to reflect, for example, new populations of patients, or data from less-common sources, such as wearable devices.

The project’s first model released today calculates the value of treatments for rheumatoid arthritis, an autoimmune disease, where the immune system is tricked into attacking healthy cells, that leads to inflammation of joints — wrists, fingers, feet, and ankles — and surrounding tissue. The web site RheumatoidArthritis.net cites data showing some 1.3 million people in the U.S. have the disease, making it the most prevalent autoimmune disorder, exceeding psoriasis, Crohn’s disease, and type 1 diabetes.

The Open-Source Value Project’s rheumatoid arthritis model offers an online calculator where users can enter variables including the patient population, sequence of treatments for patients, and the costs for those treatments. Users can accept default values offered by the model, or enter their own variations. The model then returns changes in patients’ functional status, life expectancy, and total health care costs for each treatment sequence.

In addition, the calculator provides estimates of number of days in the hospital, earnings reductions for patients, and expected number of serious infections, a potential side effect of some treatments. And the model provides two ways of computing value, from the perspective of cost-effectiveness, or incorporating other criteria. Users of the rheumatoid arthritis model can customize their calculations further with an instance of the R statistics package, and source code for the model can also be downloaded.

The Innovation and Value Initiative has an advisory board with representatives from drug companies, industry associations, patient advocacy groups, and regional health systems. The effort’s executive director is Darius Lakdawalla, a health care economist at University of Southern California, where he chairs the school’s program in pharmaceutical development and regulatory innovation.

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