Research update: Center for Enhanced Value Assessment (CEVA)

Date: March 8, 2021


The Center for Enhanced Value Assessment (CEVA) headquartered within the Center for the Evaluation of Value and Risk in Health (CEVR) at Tufts Medical Center, was created on February 1, 2019 through a 3-year grant from the PhRMA Foundation as part of the Foundation’s Value Assessment Initiative.


CEVA’s mission is to explore the quantitative incorporation of all salient elements of value into traditional measures used in health technology assessments.


CEVA is part of the Center for the Evaluation of Value and Risk in Health (CEVR) at Tufts Medical Center, and serves as a platform to focus on a relatively recent phenomenon, namely the proliferation of health technology value assessment frameworks in the United States.  CEVA aims to develop and disseminate default procedures and assumptions for the estimation of novel value elements.

A key aspect of value assessment is selection of the value components to include. Authoritative groups, such as the Second Panel on Cost-Effectiveness Analysis in Health and Medicine, have promoted the quality-adjusted life year (QALY) as a measure of health benefit.  Prominent value assessment frameworks in the US and the UK likewise highlight results based on QALYs, for example, assessing value in terms of an intervention’s cost-per-QALY gained.  Although assessments sometimes recognize other value components, those components tend to feature in alternative analyses or sensitivity analyses.

Measures like the QALY, however, may not fully capture patient and societal well-being. CEVA’s mission is to explore the quantitative implications of incorporating non-traditional value elements into cost-effectiveness analyses. CEVA will also characterize stakeholder preferences related to novel value elements through the engagement of patients, health insurance companies, and therapeutic area leaders. By seeking to account for all elements of value that matter to decision makers, CEVA’s work may help decision makers as they consider coverage and reimbursement of new technologies. CEVA will support future work by developing tools and publicly available resources to improve consistency across health technology assessments (HTAs).


Spotlight on CEVA


Measuring “Fearonomic Effects” in Valuing Therapies: An Application to COVID-19 in China

Siyu Ma, David D. Kim, Joshua T. Cohen, Peter J. Neumann

Value in Health. July 27, 2020

Key takeaways:

  • A recent ISPOR special task force (STF) report has suggested “fear of contagion” as one of the important elements to consider when assessing the value of vaccination and other interventions, yet empirical estimates of such impact lack.
  • We provide a checklist that includes specific behavioral responses to the fear of contagion by individuals, businesses, and government. Applying our checklist to quantify the immediate economic impact in response to the COVID-19 epidemic in China, we estimated $275 billion loss during the Lunar New Year week, accounting for 1.9% of China’s 2019 GDP.
  • Researchers and policy makers consider the broader economic and social consequences (i.e., fear of contagion) when valuing future vaccines, treatments, and other strategies to address COVID-19 and other infectious diseases.

Perspectives and Costing in Cost-Effectivness Analysis, 1974-2018

David D. Kim, Madison C. Silver, Natalia Kunst, Joshua T. Cohen, Daniel A. Ollendorf, Peter J. Neumann

Pharmacoeconomics, July 22, 2020

Key takeaways:

  • As the choice of perspective and included cost components may have a substantial impact on the cost-effectiveness of interventions, the comprehensive analysis of the use of perspective and costing approaches in published CEAs is needed.
  • When a societal perspective was used, authors often did not apply it as broadly as intended. Only a few non-health consequences, such as productivity or transportation, were considered, whereas broader non-healthcare sector impacts were seldom examined.
  • The consistent use of the impact inventory and reporting of disaggregate outcomes can help reduce discrepancies across analyses capturing non-health consequences.


Valuing And Pricing Remdesivir: Should Drug Makers Get Paid For Helping Us Get Back To Work?

Joshua T. Cohen, Peter J. Neumann, Daniel A. Ollendorf  

Health Affairs Blog, May 20, 2020

Key takeaways:

  • ICER’s remdesivir assessment values health benefits accruing to the patient but omits benefits accruing to the wider society.  Because so much of the pandemic’s cost stems from social distancing measures imposed to reduce the care burden on hospitals, ICER’s omission of remdesivir’s impact on hospital length of stay in their assessment of that therapy may have led them to substantially underestimate the therapy’s value.


Analyzing the Cost Effectiveness of Policy Responses for COVID-19: The Importance of Capturing Social Consequences

David D. Kim, Peter J. Neumann

Medical Decision Making, May 19, 2020

Key takeaways:

  • Economic analyses of policy responses to address the COVID-19 pandemic can shed light on the tradeoffs inherent in alternative policy options. However, such analyses can lead officials astray if underlying data and assumptions do not reasonably capture all relevant benefits and costs.
  • We have modified the generic impact inventory to list possible health and social consequences of current mitigation strategies. This list is not intended as an exhaustive inventory but rather as a set of key items for analysts to consider in order to capture the full health and social consequences of policy interventions.
  • By providing such an inventory to accompany analyses, the list can signal to audiences which consequences have been included or excluded in cost-effectiveness estimates.

The societal perspective in cost-effectiveness analysis: ICER has done its part. Now it’s industry’s turn to step up

Joshua T. Cohen

CEVR blog, February 18, 2020

Key takeaway:

  • ICER’s third framework, adopted in January 2020, puts the societal perspective on par with the health care payer perspective.  In concept, ICER assessments will, going forward, recognize these costs, and that could have an important impact on estimated cost-effectiveness, especially for chronic conditions that involve substantial, informal caregiver effort – like dementia.  But don’t count on that outcome.  Developers of therapies must be proactive because ICER will only recognize societal costs if their importance has been documented.

Efforts to Measure Value in Health Care: Greater Balance is Needed

George Miller, Peter J. Neumann

Concept paper in collaboration with Altarum, July 2019

Key takeaway:

  • The overemphasis of cost-effectiveness analyses on pharmaceuticals and medical devices, though declining slightly in recent years, means that other clinical services, such as medical and surgical interventions, continue to be relatively neglected in comparison.


“The Impact of Social and NOVEL Elements on Cost-Effectiveness Analysis: Two Case Studies”

Siyu Ma, Virtual ISPOR 2021 (forthcoming)

“Perspective in Cost-Effectiveness Analysis: 2nd US Panel’s Deliberations and Practical Guidelines for Analysts”

David D. Kim, The Institute for Technology Assessment (ITA) at Mass General Hospital (MGH)

Webinar, December 2020

“Perspective in Cost-Effectiveness Analysis: 2nd US Panel’s Deliberations and Practical Guidelines for Analysts”

David D. Kim, The Health Economics Research Group (HERG) Monthly Seminar at the Centers for Disease Control and Prevention (CDC), Webinar, September 2020

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