Decision-makers are a fundamental part of Health Economics and Outcomes Research. HEOR is performed and used by many stakeholders and payers who may not be on the frontline of the work done in this field.
But who actually makes the decisions?
Fortunately, there are experts that develop new methods contributing to the decision-making process by informing with real-world evidence and data. These HEOR stakeholders can have different origins and fields of expertise, as we will see in this article.
The Increasing Complexity of Healthcare
The healthcare systems field works very closely with economic models, real-world data, and pharmaceutical companies around the globe.
Nowadays, the increasing complexity of healthcare creates enormous pressures in the healthcare ecosystem, and stakeholders need to address this issue. Moreover, the demographic shift and the country of residence make stakeholders address these challenges with different priorities and interests.
A higher life expectancy and improved levels of health in the population are particularly noticeable in the OECD countries. On average, healthcare spending represented approximately 9% of GDP in 2016, but the COVID-19 pandemic signified a big change.
For example, health spending grew 3.4% in 2021 in the United States, according to an Altarum report.
Even though some countries are progressing toward collectively funded healthcare systems, like China, lower-income countries’ struggle continues as they develop basic health systems and services.
Innovative treatments and personalized medicine systems are the main pillars of strategic planning for healthcare payers and HEOR professionals as they play an important role in market access and drug pricing. This added complexity makes it more difficult to perform a healthcare evaluation of costs by patients, payers, and healthcare budget-planning processes.
The increased access to healthcare and the focus on healthcare equity promoted by the World Health Organization (WHO) are also challenging factors.
Who Are the HEOR Stakeholders?
HEOR stakeholders can come from multiple fields, such as:
- Commercial health plans
- State and local governments
- Pharmacy benefits managers
- Group purchasing organizations
- Individual clinicians
- Multi-specialty practices
- Health care delivery networks, IDNs
- Specialty pharmacies
- Patients and caregivers
- Pharmaceutical manufacturers
- Device manufacturers
- Health policy and regulatory stakeholders
- U.S. Food and Drug Administration (FDA)
- Centers for Medicare and Medicaid Services (CMS)
- State governments
The Evolution of HEOR and Healthcare Decision Makers
Not so long ago, HEOR experts worked in the health technology sector (e.g., health informatics industries, biopharmaceutical companies, medical device and diagnostics, and life sciences companies), in HTA, and in academic centers with research programs involving health economics, epidemiology, and other expertss.
Those who work with HEOR data and resources, such as payer/budget holders, health IT professionals, and actuaries, have seen their decision-making process become more complicated.
Today, a vast amount of data goes into outcomes research and health economic analyses, starting at the patient and caregiver levelscaregivercaregivers level, being that these two stakeholder groups are the ultimate ultimatelyultimatelye beneficiaries of any decision. Defining and determining value is at the core of HEOR. Obtaining feedback from patients or their representatives may bring vital information essential to an adequate and informed decision. The definitions of value are closely related to the clear understanding and measuring of patients’ health outcomes and treatment results.
At the same time, stakeholders are helped in their decisions by knowing which health benefits are displaced by investing in new technologies.
There is a need for healthcare systems and patients to inform in real time, aiming to know the performance of treatments in order to compare to other benchmarks for quality feedback. Not only that, this real-world evidence and data function at the patient-level decisions by providing the right drug or dose at the right time and location.
A World of HEOR Data and Collaboration
These are times of big data and an increasingly complex digital world to navigate in. There is a huge amount of information and tools to recompile the outcomes data needed for the value-determination process of healthcare treatments patients and the use of the right data to make sound good decisions in the real world.
For example, new pharmaceuticals generate tons of data used by regulatory and HTA bodies in terms of clinical studies and randomized controlled trials (RCTs). HEOR researchers work with clinical study teams to include HEOR endpoints and other data needed to have a broader perspective. Moreover, clinical research and HEOR collaboration increases, providing more relevant RCTs that are informing to the real-world clinical practice and answering questions to provide high-value care efficiently. These data allow This data allows an understanding of how real-world technology performance differs from clinical trial settings.
To properly analyze the cost of care, the magnitude of benefit, and the volume of patients treated, HEOR analyses—that include these uncertainties—are performed. In everyday practice, technologies are used in populations and under conditions different from controlled research settings. HTA agencies have long used this information for coverage determination processes by payers and budget holders.
Many data scientists often collaborate with HEOR experts, and many of the methods are connected to economic methods, psychology, actuarial science, and biostatistics. Good practices and guidelines developed in HEOR inform those of data analytics. This complex collaboration and powerful data collection to assess safety and effectiveness of treatments is now a vital part of the healthcare and life sciences ecosystem.
Frequently Asked Questions (FAQ)
What are HEOR services?
HEOR generates evidence of the value of a new drug or intervention for reimbursement and healthcare payers. It establishes the link between treatment and the actual outcomes, providing evidence-based guidance on how to improve healthcare as a result. The information comes from clinical trial data, clinical outcomes, and financial considerations with less tangible measures such as quality of life.
What can HEOR data be used for?
HEOR data can be used to establish reimbursement structures, identify successful interventions, guide healthcare coverage and market access decisions, close the gap between clinical trial results and real-world outcomes, identify the most effective interventions for specific populations and patients, and help pharma companies communicate their innovations to stakeholders such as payers, physicians, and patients.
How do pharmaceutical companies estimate drug sales and forecast?
The process is known as Pharmaceutical Forecasting, which comprises the tools and techniques to analyze the market performance of a drug in development. The factors that are taken into consideration are the following, among others:
- Disease factor
- Drug factor and competitor factor
- Patient factor
- Generation of revenue
- Pharmaceutical product pricing
The consumer is basically paying for the research and development wing of the pharmaceutical company and the costs incurred during several years of development. The one product that accesses the market must generate revenue for all missed products, which can be thousands of them—hence the high market costs of some drugs.