For a patient with cataracts, a simple operation can restore vision to 20/20. But those numbers probably matter less to him
than his ability to get behind the wheel, read a newspaper, and take his grandchildren to the movies.
The clinical trial process, by and large, isn't set up to answer questions about what patients most value. It's about numbers—time
to disease progression, cholesterol levels, blood pressure—rather than quality of life.
Yet at a time when healthcare costs are ballooning rapidly—along with the tools available to intervene in just about every
disease—quality of life factors must be considered alongside clinical data, argues Melissa Brown, MD, director of the Center
for Value-Based Medicine.
She and her husband, Gary Brown, MD, and colleague Sanjay Sharma, MD, have attempted to quantify the value of popular drugs
and medical procedures. Their book, Evidence-Based to Value-Based Medicine, plots the cost-effectiveness of popular drugs and medical procedures as a function of their efficacy, adverse effects, and
Here, Melissa Brown discusses what's driving the move toward value-based medicine, how it will affect pharma, and why executives
should embrace it.
What inspired this book?
Even before it became a hot topic, we could see that the percent of GDP that we were spending on healthcare was going up.
I didn't think—in the United States anyway—that we had a clear picture of how to evaluate things from a value standpoint.
We seem to believe that it's not palatable to look at things from a monetary perspective. But we spend over $2 trillion a
year on healthcare—if we were just a little bit wiser, spending it more efficiently, the sky is the limit as to what would
be available to everyone.
When we looked at what had already been written about healthcare costs, there were books that did a great job of starting
to outline some of the issues and some of the problems. But they weren't able to come up with enough specific suggestions
that would allow researchers to do cost-effectiveness evaluations with consistency. And the piece that we found that was not
at all well-standardized was the quality-of-life assessment. That's what we centered on when we began researching our book.
We spent a lot of time doing an investigation into what we thought was, in our hands, a good way to evaluate quality of life,
and settled on, for a lot of reasons, time trade-off. From there we could do a blueprint for a cost-utility analysis, which
would allow us to calculate value in medicine. Because if we can't allow our patients to have the very best value in healthcare—and
by value I don't necessarily mean money, I mean value in improving the length or quality of life—then we're not doing such
a great job as healthcare workers.
How did you define "value-based medicine" in your book?