Another report in the same issue of the Annals of Internal Medicine focuses on the relevance of 3 concepts that can help in understanding the value of clinical interventions for those involved in clinical decisions (Owens DK, et al. Ann Intern Med. 2011;154:174-180). The authors define value as “an assessment of the benefit of an intervention relative to expenditures.”
The distinction between cost and value is crucial, the authors suggest: interventions with high cost may nevertheless provide good value, because they provide a great clinical benefit. By contrast, inexpensive interventions may be tempting because of their low cost but may actually have little value, because they offer no or only little clinical benefit. Differentiating between cost and value is therefore important to clinical decision-making; supporting high-cost, high-value interventions may be justified even in a cost-conscious healthcare system.
The key to slowing the rate of cost escalation is not to avoid using highcost interventions: the challenge is to promote high-value and high-quality patient care, and this may include high-cost interventions. The first step to increasing value in clinical care is to reduce or eliminate interventions that provide no benefit and may often be even harmful. Next, it is necessary to promote interventions with high value, that is, those that provide a clinical benefit that justifies the cost. Finally, when assessing the value of an intervention, it is critical to include not only the cost of the intervention itself but also any additional cost that may be added or prevented to the total cost of care for that patient as a result of the original intervention (eg, cost or prevention of side effects, disease progression).
