Patient value: its nature, measurement, and role in real world evidence studies and outcomes-based reimbursement

Abstract

The assessment of “patient value” is fundamental to clinical trials, real world evidence studies, and outcomes-based reimbursement schemes. Measures of health-related quality-of-life (HRQoL) are widely used in health research. Such measures are effective in determining the presence or absence of symptoms and functional ability. However, HRQoL measures were not intended, nor designed, to determine the value to patients of alternative health states. Functions have no intrinsic value—they are a means to fulfil human needs. However, needs can be met in a variety of ways, for example by adopting different functions or by the provision of social services. It is possible to analyze all functions in terms of the needs they satisfy. A needs model has been applied in health research since the 1990s. It is concerned with the extent to which human needs are fulfilled in the presence of disease and its treatment. It is argued that this is the major concern of the patient. Needs-based measures are patient-centric and produce a valid unidimensional index of outcome. Consequently, they provide a direct means of measuring patient value. This approach provides the possibility of evaluating health services in terms of the value they provide to consumers and payers. It also has a role to play in real-world evidence studies and outcomes-based reimbursement. It is recommended that greater attention is given in future to the development of patient-reported outcome measures that provide direct assessments of patient value.

Keywords:

• Health-related quality-of-life
• health service evaluation
• needs-based quality-of-life
• outcomes-based reimbursement
• patient reported outcome measures
• patient value
• real world evidence

Transparency

Declaration of funding

This manuscript was not funded.

Declaration of financial/other relationships

The authors develop needs-based outcome measures. JME peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

None reported.