A rapid review of the literature contrasting cost-effectiveness analysis and value-based healthcare approaches to assess how these paradigms are complemented in the context of health care in Wales

Methods of economic evaluation, such as Cost-Effectiveness Analysis (CEA), and approaches to Value Based Health Care (VBHC) are both being used in Wales, UK. They have similar goals in terms of maximising benefit as described by costs and outcomes. However, these approaches serve separate aims and fulfil different needs in healthcare delivery. The aim of this review was to contrast, and where possible describe, the complementarity of CEA and VBHC approaches to maximising value to healthcare systems. The objective was to review published literature contrasting these approaches in terms of their aims, perspectives of analysis, mathematical approach, and strengths and limitations. Given that these two approaches are being used in Wales, we were interested in the most appropriate positioning of these approaches across the landscape of decision-making from Welsh Government down to seven health boards across Wales. The review was informed by input from health economists, VBHC leaders, and Welsh Government stakeholders, although no direct comparisons within the Welsh system were made. The review included evidence published between January 2004 and January 2024. Database searches were conducted on 10th January 2024. The study found that both CEA and VBHC aim to maximise value in healthcare; however, these approaches differ in their specific definitions of value and in their applications. An augmented approach to economic evaluation highlights multiple elements of value, showing how traditional CEA and broader value-based perspectives can complement each other to capture both efficiency and patient-centred outcomes.Most of the papers identified in this review have come from authors from US research institutions and therefore caution is required when considering the applicability of the findings to the UK healthcare system. The VBHC framework adopted in the UK focuses on improving patient outcomes relative to fixed and constrained resource use. More work is required to make the connection between CEA and VBHC approaches when developing policy initiatives that promote efficiency and equity. Open discussions among clinicians, researchers and policy-makers are required around the need for broader frameworks that capture the dynamic nature of value to present the changing preferences of individual patients and society over time. Further research is also needed to explore recent refinements or alternatives to the traditional cost per QALY framework.