OBJECTIVES: To investigate (1) whether payers have higher willingness to pay (WTP) for interventions that meet novel value criteria: groundbreaking durable/curative, disease severity, and health equity; and (2) for relevant interventions reviewed by ICER from 2021‒2023, how many additional treatments would be deemed cost-effective at higher WTP thresholds.

METHODS: A double-blinded web-based survey of US healthcare payers was fielded in July 2023 through Cencora’s research panel, the Managed Care Network, to assess payer WTP for interventions meeting novel value criteria. Identified ICER reports assessing pharmaceutical interventions published between Mar 2021 and Nov 2023 that included an appraisal committee (AC) meeting (N=54). Determined whether an intervention met novel value criteria based on surrogate measures: (1) groundbreaking durable/curative: use of single and short-term therapies (SST) framework (n=6); (2) disease severity: ≥50% AC voted disease had high acuity of need (n=7); and (3) health equity: ≥50% AC voted intervention would have positive impact on health inequities (n=5).

RESULTS: A total of 48 payers participated in the survey. Most payers strongly agreed/agreed they would pay more per unit of health gained for groundbreaking durable/curative treatments (75%). Fewer strongly agreed/agreed they would pay more per unit of health gained for interventions that treated higher-severity diseases (40%) or reduced health inequities (33%). At a WTP threshold of $100,000, ICER found 3 “groundbreaking durable/curative” treatments cost-effective (50%), 1 “disease severity” treatment cost-effective (14%), and 1 “health equity” treatment cost-effective (20%). At WTP threshold of $200,000, the respective numbers rose to: 6 (100%), 4 (80%), and 2 (29%). At $300,000, the numbers rose to: 6 (100%), 5 (100%), and 3 (43%).

CONCLUSIONS: Some payers are willing to pay more for interventions meeting novel value criteria. With increased WTP thresholds, more interventions meeting novel value criteria would be considered cost-effective, with potential implications for formulary decision-making and patient access.