Building blocks of value creation within value-based health systems: a Delphi study

Objectives Health technologies can provide significant value to health systems; however, identifying and structuring the factors that drive this value is crucial for informed resource allocation. This study aims to develop a consensus-driven framework that defines the key factors influencing value creation in health technologies and identifies system-level barriers that may limit their potential impact. Methods A mixed-method approach was used, starting with a targeted review, resulting in 21 frameworks that informed an initial framework draft. A 3-round web-based Delphi exercise was conducted with 22 experts from academia, industry, patient representation, policy making, and healthcare regulation. In round 1, participants contributed value statements—specific characteristics influencing value creation—within the initial framework. Thematic analysis using NVivo consolidated these into a comprehensive framework. Rounds 2 and 3 involved participants rating the importance of these cocreated statements on a 5-point Likert scale. Results The scoping review yielded 10 value domains (politics, health system organization, governance, financing, geographic features, population health, resource generation, providers, private industry, and technology features) with 46 subdomains. The Delphi exercise ultimately generated 61 value statements for 38 subdomains, with 17 achieving consensus and stability. Conclusions The resulting value framework offers an evidence-based, system-centered approach to value assessment, incorporating diverse stakeholder perspectives and system factors. This approach addresses gaps in current value capture. Future research should focus on validating the domains and subdomains identified in this framework across different healthcare settings.