Although current value frameworks have much to offer to decision makers, there is clearly much room for improvement, both in terms of how value is measured and how those measures are used. Oncology provides some illustrative examples of these opportunities. A common endpoint in oncology trials is progression-free survival, but its use in regulatory and payer decision making has been controversial because of its imprecise correlation with overall survival. An improvement would be to routinely measure and report patient quality of life directly during the progression-free survival period in oncology trials for incorporation into value assessments. Although quality of life is more commonly measured in oncology and other disease trials than it used to be, significant gaps in capturing the patient experience during treatment remain. With respect to use of value measures, the gaps are even more obvious. Changes in the pricing of products in recent years probably do not reflect changes in value, even adjusting for the effects of discounting on net prices. And although many products have multiple indications, few allow for prices to be adjusted when different indications have different values.
The subsequent sessions of this summit will explore these and other gaps in more detail and will suggest some specific approaches for making improvements.