Real Option Value: Should We Opt In or Out?
Abstract
The article by Li et al in this issue sets out a “pragmatic guide to assessing real option value for medical technologies.” Real option value (ROV) was included as an element of value in the ISPOR US Value Assessment Task Force Report.
A review identified several ROV estimates, and Li et al report others. Nevertheless, payers and health technology assessment bodies have, to date, shown limited interest in the concept. It was not part of the UK’s National Institute for Health and Care Excellence consultation before publishing its revised Methods Guide. It does not feature in the discussion of incremental cost-effectiveness in the Institute for Clinical and Economic Review’s 2020 to 2023 Value Assessment Framework, although the “option of receiving future treatments” is mentioned as one of the “potential other benefits and disadvantages” on page 36 of the Value Assessment Framework. ROV is discussed in a related Institute for Clinical and Economic Review Technical Brief and dismissed (pages 11 and 12) as having an “opportunity cost problem” and issues as to how to “empirically determine a weighting” for ROV. Arguably, it does feature as a Scottish Medicine Consortium’s modifier, which includes “possible bridging to another definitive therapy (eg, bone marrow transplantation or curative surgery),” although the implication of “definitive” may be that the therapy is already available.
A review identified several ROV estimates, and Li et al report others. Nevertheless, payers and health technology assessment bodies have, to date, shown limited interest in the concept. It was not part of the UK’s National Institute for Health and Care Excellence consultation before publishing its revised Methods Guide. It does not feature in the discussion of incremental cost-effectiveness in the Institute for Clinical and Economic Review’s 2020 to 2023 Value Assessment Framework, although the “option of receiving future treatments” is mentioned as one of the “potential other benefits and disadvantages” on page 36 of the Value Assessment Framework. ROV is discussed in a related Institute for Clinical and Economic Review Technical Brief and dismissed (pages 11 and 12) as having an “opportunity cost problem” and issues as to how to “empirically determine a weighting” for ROV. Arguably, it does feature as a Scottish Medicine Consortium’s modifier, which includes “possible bridging to another definitive therapy (eg, bone marrow transplantation or curative surgery),” although the implication of “definitive” may be that the therapy is already available.
Authors
Adrian Towse