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Speaking of value

Better understanding and more consistent use of economic terminology is needed to convey value in healthcare

Speaking of valueNumerous forces are influencing the way in which value in healthcare is defined and communicated throughout the world. These include:

•    Greater focus on healthcare quality and evidence-based medicine

•    Impact of healthcare reforms, especially in the US

•    Greater regulatory scrutiny of healthcare costs and pharma spending

•    Demand for outcomes information to better understand the comparative effectiveness of treatments.

As the trend toward outcomes-based evidence in healthcare grows, the scientific literature is increasingly incorporating health economic evaluations into peer-reviewed publications to demonstrate value. Commonly used terms to convey value in healthcare, such as efficiency, effectiveness, evidence-based medicine, cost effectiveness and comparative effectiveness are increasingly finding their way into clinical papers and review articles, yet it is not always clear that these terms are being used in a consistent manner.

Moreover, researchers and product developers are publishing to a wider audience of stakeholders, including health economics and outcomes research specialists; health technology assessment bodies; health policy and regulatory bodies and commercial and government payers. Definitions have evolved substantially in recent years, as have the use of evidence based medicine, health technology assessment and comparative effectiveness research to underlie economic evaluations and demonstrate value.

Demonstrating value
Achieving value is a fundamental goal of healthcare delivery. Value demonstration should be based on a consistent lexicon for communicating the performance of medicines. Yet value-related terminology is often inconsistently used in medical publications and may convey unclear information. In this era of increasing demand for well-defined demonstrations of value, it is important to understand how health economic information is incorporated into biomedical journals and how key terms are being used to convey value.

To this end, PAREXEL's medical communications team and reimbursement & market access practice explored commonly used terms in the medical literature. We found significant increases in the use of health economic and value terminology between 2006 and 2009, including increases in the use of the term comparative effectiveness and references to reimbursement. We also observed inconsistency and limited understanding of the historical context among authors trying to use and define value terminology.

Value definitions
Based on our observations, the definitions below seem appropriate when speaking of value in the medical publications arena:

•    Comparative effectiveness (research): research evaluating and comparing health outcomes and the clinical effectiveness, risks, and benefits of two or more medical treatments, services and other items

•    Cost effectiveness: a term used to describe how much a drug or treatment costs per quality adjusted life year. Can also be stated 'cost of using a drug or treatment per year of the best quality of life available'

•    Reimbursement: It is the compensation for healthcare products or services, usually delivered at a pre-determined rate based on complexity and cost. It can be subdivided into provider reimbursement (for settings of care) and patient reimbursement (for certain settings of care, insurance scenarios or elective procedures).

In summary, more research is needed to understand the use of health-economic terminology to demonstrate value in biomedical literature, as well as how this terminology is being perceived by various stakeholders.


Shelley ReichParexelThe Author
Shelley Reich
, PAREXEL Medical Communications
Email her at:



1st April 2011


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