Health Economics and Outcomes Research
Research discipline that generates economic, clinical, and patient-reported evidence to support payer access, HTA submissions, and value demonstration.
Definition
Health Economics and Outcomes Research (HEOR) is the multidisciplinary field that generates economic models (cost-effectiveness, cost-utility, budget impact), real-world evidence, and patient-reported outcomes data used by payers, HTA bodies, and health systems to assess a technology's value. HEOR deliverables include the Global Value Dossier, AMCP Format submissions to US health plans, and country-specific HTA submissions (NICE, CADTH, IQWiG, HAS).What this means in practice
Strong HEOR is the difference between coverage and non-coverage in single-payer systems and is rising in importance for US commercial payers. Increasingly, HEOR planning starts at preclinical/early clinical to ensure trial endpoints support the value story.- •Designing pivotal trials around regulatory endpoints only and finding the dataset can't support the HEOR case.
- •Treating HEOR as a post-launch activity instead of an evidence-generation strategy from Phase 1.
Related terms
Grouped by themeEditor's picks
· Hand-selected related conceptsFinancial model that estimates the total cost consequences of adopting a new technology to a payer's budget over a defined horizon.
Systematic evaluation of clinical and economic value of a health technology.
Cost per additional unit of health outcome (often QALY) versus comparator.
Outcome metric combining length and quality of life used in HTA.
More in Reimbursement
· Same categoryReal-world evidence used to support coverage and payment decisions.
Federal program providing discounted drugs to safety-net providers.
The Medicare grouping system that determines hospital outpatient payment amounts under OPPS, analogous to MS-DRGs for inpatient.
Migration of procedures from hospitals to ambulatory surgery centers.
Primary references
3 sources- 1
ISPOR, Good PracticesVerifiedISPORispor.org
- 2
AMCP Format for Formulary SubmissionsVerifiedAMCPamcp.org
- 3
AMA CPT ResourcesVerifiedAMAama-assn.org
Inline markers like [1] jump to the matching reference above.