HEOR teams answer the question payers ask after regulators have approved a medicine: is it worth paying for? Their work typically includes cost-effectiveness models, which compare the costs and health benefits of a treatment with the alternatives, often expressed as cost per quality-adjusted life year; budget impact models, which estimate what adopting a treatment would cost a health system; studies of patient-reported outcomes such as quality of life; and real-world evidence studies of outcomes and resource use.
This evidence is brought together in value dossiers and submissions. In the United States, many health plans review manufacturer dossiers prepared in the format developed by the Academy of Managed Care Pharmacy. Outside the US, it supports submissions to health technology assessment bodies. In the US, the Institute for Clinical and Economic Review also publishes independent value assessments of new treatments.
HEOR sits in Medical Affairs in some companies and in market access in others. Either way, it depends on a clear view of the evidence, the competition and how assessors have judged similar products.