josh feldstein hopr (presentation)

Center for Applied Value Analysis, Inc.

200 Connecticut Ave.Fifth Floor

Norwalk, CT 06854 USA

(Direct) 203/791-8899(Main) 877/360-2282

www.cavalue.com

Comparative Cost Effectiveness Modeling: Demonstrating a Product’s Value Proposition

Comparative Cost Effectiveness Modeling: Demonstrating a Product’s Value Proposition

3rd Annual

Health Outcomes and Pharmacoeconomics Research

Josh Feldstein President and CEO

© Copyright 2012 Center for Applied Value Analysis, Inc (CAVA). All rights reserved.

© Copyright 2012 CAVA04/08/23 2

Comparative Cost Effectiveness (CCE)

CCE opens vast new pathways for industry,

providers, and payers to improve clinical outcomes

and reduce overall costs

CCE changes the way health care thinks about

health care

CCE quantifies the comparative value of

pharmaceuticals, med-surg devices and

technologies…many for the first time




(Direct) 203/791-8899(Main) 877/360-2282

www.cavalue.com

Value Analytics and CCE: A Brief Overview…

Value Analytics and CCE: A Brief Overview…

04/08/23


Profound Challenge Facing US Health Care, 1

How to manage the almost limitless flow of product innovation from industry? (Innovation does not always mean improvement)

Pharmaceutical and Medical-Surgical industry, Hospitals, IDNs, ACOs, Payers, and healthcare providers have little or no data on complete course-of-therapy (“episode of care”) economics

Scarcity of objective comparative drug / device cost effectiveness data makes true value-based (head-to-head) purchase / utilization decisions very difficult

Burns LR, Wharton School Colleagues. The Health Care Value Chain. San Francisco, CA: Jossey-Bass; 2002:269.


Profound Challenge Facing US Health Care, 2

Most hospitals seeking to cut costs by 30% over next 3 years

Government, AHRQ, Medicare focusing on CE, but COST is off the table due to political sensitivities

The “dollarized” total episode-of-care cost (i.e., total value) of a medication or medical-surgical device in the real-world clinical setting is often unknown

Increasing scrutiny of industry-provided quantification of a product’s relative value proposition

This is a huge data gap, leading to incalculably large inefficiency in healthcare delivery and fiscal wasteBurns LR, Wharton School Colleagues. The Health Care Value Chain. San Francisco, CA: Jossey-

Bass; 2002:269.


So…Overall Product Value and CCE Modeling is Becoming the New Gold Standard

Definition and Process:

A new awareness of broader, deeper data collection +

The total comparative dollar assessment of an

entire episode of patient care +

Use of CCE data synthesis methods and technologies +

Aligned HCP/Administration / Payer incentives =

Comparative Cost Effectiveness Modeling and Programs


CCE’s Impact at Hospitals and Among Payers…


And With Industry…




(Direct) 203/791-8899(Main) 877/360-2282

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Key DefinitionsKey Definitions

04/08/23 10

Comparative Effectiveness

Comparing the clinical impact / effect of one treatment vs. another treatment over an appropriate episode of care

CE usually excludes costs – May include measurement in “natural” units such

as # of pills or # of office visits, QALYs, etc.

© Copyright 2012 CAVA


Comparative Cost Effectiveness (CCE)

Adds the comparative dimension of total cost over a clearly defined episode of patient care

Looks at comparative outcomes inclusive of the economic impact of AEs, total healthcare resource consumption (time, HR, supplies, etc.), and not JUST product acquisition cost– All comparative AEs: incidence, severity, duration, and

populations identified via in-depth data collection, analysis, synthesis, modeling

Collects and presents cost (or at least resource use data) alongside the comparative effectiveness data

Provides all decision makers with very practical and important comparative product data


Key CCE Value Analytics Challenges




(Direct) 203/791-8899(Main) 877/360-2282

www.cavalue.com

CCE Modeling Needs TodayCCE Modeling Needs Today


CCE Modeling Impacts Brand Team Thinking, Strategies, Programs, and Results

To quantify objectively the value proposition of your product to purchasers and HCP stakeholders

To address the rapidly emerging New Normal: CCE

Hospitals, IDNs, HCPs, and Payers are increasingly demanding CCE from industry suppliers

Hospitals, IDNs, HCPs, and Payers are becoming increasingly dissatisfied with industry-sponsored, delivered modeling

Industry has a huge opportunity ahead

Some are resistant, some are watching and waiting, some are opportunistic…where are you?




(Direct) 203/791-8899(Main) 877/360-2282

www.cavalue.com

Value Analytic CCE ModelsValue Analytic CCE Models


Value Analytic Modeling

Rigorous yet easy-to-use management decision making tools (spectrum of weighted evidence)

Combine best available clinical and economic evidence to assess the true, comparative value of one treatment vs. another

Enable users to obtain relevant estimates of clinical and economic consequences associated with pharmaceutical or med-surg device selections

Peer-reviewed for validation


What’s inside a Value Analytic Model?

Interface and integration of medical statistics and health economics, which includes:– Methods for statistical modeling of cost data– Integration of clinical evidence within a

decision-modeling context– Includes missing data in economic evaluations

conducted alongside clinical trials– Publishable statistical (econometric) methodologies to

perform the evidence synthesis analyses


Example of an Online CCE Model Drug Input Dashboard


Sample Online Adverse Event Dashboard


Example of an Online CCE ModelDevice Output Dashboard


Sample Online CCE ModelPharmaceutical Output Example

04/08/23 22

Good Practice Standards for CCE Value Analytic Model Design

• Statement of perspective (e.g. healthcare facility, societal etc.)

• Description of strategies / comparators

• Influence diagram of model / disease pathways

• Development of model structure and assumptions discussed

• Table of model input parameters presented

• Source of parameters clearly stated

• Model parameters expressed as distributions

• Discussion of model assumptions

• Sensitivity analysis performed

• Key drivers / influential parameters identified

• Evaluation of internal consistency undertakenAdapted from Philips Z, Ginnelly L, Sculpher M et al. Review of guidelines for good practice in decision-analytic modeling in health technology assessment. Health Technology Assessment. 2004; 8(36).

© Copyright 2012 CAVA


Value Analytics Program Design

CCE Data Collection

and Integratio

n

Model Launch

Ongoing Enhancemen

ts Model 2.0+

Planning and Due Diligence

Model Structure Design

Ongoing CCE

ManagementEducatio

n


CCE Modeling: Summary CCE modeling for industry communicates your products

total value

For hospitals / systems / payers, CCE modeling result in:– Improved clinical outcomes– Health resource use offsets and reduced total costs

CCE Models deliver help identify strategies for promoting improved therapeutic purchasing choices and improved outcomes while conserving scarce health care resources

Prudently applied CCE modeling is a win-win for the entire healthcare industry, supply and HCP delivery chain

The need to evolve CCE resources and capabilities is NOW




(Direct) 203/791-8899(Main) 877/360-2282

www.cavalue.com

Comparative Cost Effectiveness Modeling: How to Demonstrate a Product’s Value Proposition

Comparative Cost Effectiveness Modeling: How to Demonstrate a Product’s Value Proposition

3rd Annual

Health Outcomes and Pharmacoeconomics Research

Josh Feldstein President and CEO

josh feldstein hopr (presentation)

Economy & Finance

health care cce

comparative effectiveness

total value

cce hospitals

care cost

health care value chain

true value

cce modelingneeds