Patient-centric HTA: different strokes for different folks

Abstract

Patient centricity will initiate a change in healthcare decision-making paradigms. Patient-centered outcomes are a part of the solution to the challenges posed by complex decision problems due to multiple clinical and non-clinical outcomes. Multiple decision criteria require that clinical and regulatory decisions be based on the implicit value judgments of experts. Experts are under continuous pressure to ensure decisions are aligned with patient needs and result in positive performance. To fulfill this role and guarantee efficient decisions, experts must be fully informed about patient preferences; however, this assumption might not necessarily reflect reality. Health technology assessment focuses on the measurement of clinical effects, rather than the assessment of the impact of different outcomes on users’ perceived value. Further evidence is needed to ensure that expert judgments are congruent with patient preferences. Therefore, patient preferences can be a valuable source of information to inform clinical and regulatory decision-makers.

Keywords:

• health technology assessment
• multi-criteria decision-making
• patient centricity
• patient heterogeneity
• patient preferences
• patient segmentation
• patient-centered health care

Acknowledgements

The author would like to thank Valerie Mörk and Susanne Bethge, Hochschule Neubrandenburg for assistance and valuable comments.

Financial & competing interests disclosure

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Decision makers are confronted with different decision criteria. Healthcare decisions are complex due to multiple decision criteria and stakeholders.

• The current discussion stipulates that decision criteria must be relevant to the patient. Patients might value different clinical end points differently.

• Clinical decision criteria are not perceived as equally important by patients. Therefore, multiple end points have to be weighted to make rational decisions.

• The paradigm of patient centeredness aims to ensure that the interests of patients are adequately taken into account. Therefore, patient segmentation is the key to patient-centered healthcare systems.

• Patient segmentation should be based on patients’ preferences. The integration of patient preferences with expert value judgments will improve regulatory decision making. Patient-centric health technology assessment must inform decision makers about patients’ preferences.