Market access focuses on demonstrating the value of new technologies (drugs, devices and diagnostics) to payers and decision-makers. Manufacturers are used to providing technical documents with complex evidence of value to various health technology assessment (HTA) agencies, and are also adept at developing value messages aimed at prescribers. However, communication of such value propositions to non-technical audiences is often less well presented.
This may be due to the complex nature of the evidence of value that is developed by manufacturers and HTA agencies alike. Such evidence is based on data from clinical trials and economic modelling, which are by nature complex. Measures like progression-free survival and cost per QALY are not easy concepts to convey to the non-medically trained.
One aspect that is easily understood by all audiences is price. It is therefore no surprise that HTA agencies have used pricing arguments successfully in their communications surrounding negative opinions or restrictions or comments about the cost of new technologies in general. However, manufacturers could use the same price argument to make two points; they could demonstrate the percentage of the healthcare budget that would actually be used by their product. If this is not very high, this would help counter any arguments proposed by purchasers or HTAs relating to high price. But more importantly, manufacturers could also point out that high prices are a reward for innovative products, where higher prices act as a stimulus to ensure the willingness and ability of manufacturers to continue to invest in R&D. The flipside of this argument is of course that me-too drugs would not demand a premium price.
The real challenge lies in how best to communicate on efficacy and other aspects of value. As mentioned before, intermediate endpoints or complex outcome measures are challenging to use in any communication to wide audiences. Like HTA agencies, patients have a preference for so-called 'hard endpoints' such as survival, or clinical outcomes like myocardial infarction, stroke or blindness as these represent clear concepts. However, when using these clinical outcomes to demonstrate the value of a new technology, they do not necessarily allow individuals to understand how the new technology compares to similar treatments in the same disease area, nor does it allow for comparisons outside the disease area. In Europe, most access decisions are related to comparability of value and several HTA agencies have used a single yardstick, in various cases the QALY, with which all new technologies can be measured and compared between them, regardless of therapeutic areas. Therefore in simplifying any message of value, a component of comparability should be included. The real challenge lies in finding a better approach, while avoiding the QALY, to bring additional clarity into the discussion of value.