Health care costs in the United States have been rising faster than the rate of inflation for some time. US health care spending increased by almost 10% to reach 4.1 trillion US dollars in 2020. Yet, many policy responses to address rising costs focus on changing spending by controlling the adoption of new technology—while ignoring the fact that a large portion of spending growth in health care is driven by non-drug items and services for which value is very poorly understood.  It will be difficult if not impossible to put U.S. health care on a truly sustainable footing if we do not demand accountability for value across the system.

Yet today, the formalized, independent assessment of value in health care is mostly applied to medicines and medical technologies. Medicines represent roughly 15% of US health care expenditures, yet they are the focus of almost half of published cost-effectiveness analyses and are in a sense disproportionately  “under the lamppost” as policymakers and experts look at how to bring better value and affordability to the health care system.

While it is important to analyze the value of new medicines and to account for all aspects of value that matter to patients in value assessments, we should pursue these objectives for other aspects of the health care system as well. We need to be able to see the entire street, not just the bit of sidewalk under the lamppost.

A key reason for relatively little focus on health technology assessments (HTA) for non-drug health services and procedures is the absence of suitable data. Most services and procedures do not have readily available data on intervention effectiveness, given that they are not regulated by the FDA, and thus randomized control trials are not required as they are for medicines or many medical devices. Cost data are also not as readily available.  Moreover, there is often substantial price variation for procedures and other services

But there is a path forward. Rapid growth in real-world data can capture information on costs and health outcomes for all types of services. Real world data can help us measure what matters to patients and caregivers across the continuum of care. Greater use of data sources outside of FDA required trials opens more possibilities to measure value in ways that aligns with patients’ preferences, and recognizes how patient-important outcomes can vary between disease areas and patients. Meanwhile, new and creative methods are emerging to assess the value of medicines with efforts to promote the capture of outcomes that matter to patients and society, risk preferences, other novel value elements, and biomedical innovation and transparency.

Given the availability of different data sources and emerging methods improvements in HTA, there is ample opportunity to address gaps in data to apply HTA to nondrug services.  But more guidance is needed.