Welcome to the

IVI-RA Value Tool

The IVI-RA Value Tool is an interactive tool that provides decision-makers with information on the value of different pharmaceutical treatment options for moderate to severe rheumatoid arthritis (RA). The IVI-RA Value Tool is designed to support population-level decisions around how to best allocate limited health care dollars. For examples of different potential applications of the tool, or to learn more about how the model works, see our About page. By proceeding, you acknowledge and accept all terms and conditions .

The IVI-RA Value Tool is driven by the IVI-RA model and is part of the Innovation and Value Initiative’s Open Source Value Project, which seeks to advance consensus-driven approaches to measuring value in the healthcare system. The IVI-RA Value Tool is only one of several ways to interact with the IVI-RA model and participate in the Open Source Value Project. For other ways to access the IVI-RA Model, including running fully customizable analyses with the iviRA R Package and the IVI-RA Model Interface, click here.

Get started by answering a few questions

The IVI-RA Value Tool simulates the average lifetime value of treatments for a population of patients with moderate to severe RA. The results of the simulation depend on a number of factors including the characteristics of the patient population, the treatments used, and the costs of drugs. Setup the model below.

RA treatment history

Are patients using their first bDMARD or have they previously been treated with a bDMARD that failed to work? bDMARDs are biologic disease-modifying anti-rheumatic drugs.

Gender ratio

What share of the rheumatoid arthritis population is female?


What is the average age of a rheumatoid arthritis patient?

Sequences of RA treatments to compare over patients' lifetimes

Choose up to three RA treatment sequences below. As a modeled patient’s RA progress over their lifetime, they will move from each treatment to the next, in order, based on effectiveness, side effects, and other factors. Each treatment or treatment combination will occur in sequence, without overlap. Simulated patients will progress through these treatments in order, from left to right and top to bottom in the fields below (same order as reading this page).

To add a treatment to a sequence: Click in a field below to see the drop-down menu. (Note: Be sure to click in the white space; clicking on a treatment in the field will select the treatment.) Select treatments from the drop-down menu to add them to the sequence in the order you want them to occur.

To remove treatments from a sequence: Pressing the delete or backspace key while the dropdown menu is open will delete the last treatment in the sequence. You can also click on a specific treatment in the sequence and press delete to remove it.

Treatment costs

The prices below reflect drugs' wholesale acquisition cost (WAC), which is the manufacturer's list price to wholesalers. The actual price of drugs in the marketplace is equal to the WAC minus a discount, however. In the table below, you can directly edit the price (currently based on the WAC), the rebate (as a fraction of the price), and the cost of administration for drugs that must be administered by infusion.

We’re generating your results

This should take between 10 to 30 seconds.

What kind of results will I see?

The model produces results that can be used to examine the value of pharmaceutical treatments for moderate to severe RA:


The IVI-RA model simulates health and economic outcomes averaged across patients in a population. These outcomes are the results generated by the model itself. These are the results you will see next, and are under the Outcomes tab above.


By combining the information produced on patients’ health, costs, and other factors, there are various ways to calculate and compare value. The IVI-RA Value Tool includes two different approaches decision-makers in the health system might use when thinking about how to best spend healthcare dollars: cost-effectiveness and multi-criteria decision analysis. Both approaches are included under the Value tab.


There are a number of ways to calculate value and the Value tab may therefore not incorporate all elements that matter to decision-makers– for example, how different treatments impact the American economy. To examine the impacts of different approaches to calculating value, be sure to check out the Explore page.

Next step

Examine the health and economic outcomes predicted by the model.

Clinical and economic outcomes from treatment

The model simulates clinical and economic outcomes over patients' lifetimes. The following results show the lifetime outcomes predicted by the model, based on your selections from the Setup page.

Note: The charts below report the mean results for each treatment sequence. The black bars indicate 95% credible intervals, or, the range of values in which the simulated mean values would lie with 95% probability. For a specific mean value and credible interval, hover your mouse over a bar above

The impact of RA on patients’ functional status is commonly measured using the Health Assessment Questionnaire (HAQ) disability index for Rheumatoid Arthritis. The results depicted here show changes in HAQ from the start to the end of the simulated patients’ lifetimes. A higher HAQ score is associated with worse functional status, so an increase over time (positive change in the chart) reflects a worsening of functional status, and vice versa.
Evidence suggests that RA impacts mortality as well as morbidity. The results shown here are the average numbers of years lived for patients in the specified population.
The healthcare costs associated with RA include: the costs of biologics and other drugs, general management costs, costs due to hospitalizations, and serious infection costs. Costs are in 2017 US dollars.

RA patients may spend time in the hospital during a flare-up or when their disease or treatment causes other complications.
Poorly controlled RA can make it impossible for working-age patients to continue working, which can greatly impact patients’ earnings over time. Results reported in 2017 US dollars.
Developing serious infections is potential side effect of RA therapies. Serious infections can have large impacts on short and long-term health outcomes and are costly to the health system.

Note: The mean number of serious infections are per 1,000 patients.

Next step

Value assessment approach #1: cost-effectiveness analysis

Cost-effectiveness analysis (CEA) is a well-established approach for comparing the costs and benefits of alternative treatments. The cost-effectiveness of a treatment is typically assessed relative to a comparator, such as the current standard of care. When a new treatment is more expensive than the comparator but improves health, its value can be assessed using the incremental cost-effectiveness ratio (ICER), which divides the cost increase by the gain in health. The gain in health is frequently measured using quality-adjusted life-years (QALYs), which is a measure that combines life expectancy and quality of life.

Your selected treatment sequences

The treatment sequences you selected are shown in the table below. In the leftmost column, choose the treatment sequence that you would like to use as the comparator by clicking on the radio button.

Value of a QALY

To determine whether a treatment sequence is cost-effective, a decision-maker must place a value on a QALY, also know as their willingness to pay. For example, if the willingness to pay for a QALY was $150,000, then a treatment would be deemed cost-effective (relative to the comparator) if the added cost was less than $150,000 per QALY gained. Choose the willingness to pay in the box below.

Cost-effectiveness table

Cost-effectiveness plane

In the cost-effectiveness table, the ICER is a single value; however, in truth, there is considerable uncertainty around this number. The cost-effectiveness plane is a common way to assess this uncertainty. The cloud of points are from separate simulations and reflect the range of possible outcomes based on scientific uncertainty. A treatment is cost-effective with high probablity if the majority of points lie to the right of the red willingness to pay line (which is based on the willingness to pay value chosen above).

Monetized value of each treatment sequence

The value of the selected treatment sequences can also be assessed by assigning a monetary value to a QALY. Total benefits reflect the monetized value of QALYs less the costs associated with treatment. This plot displays this monetized value, which is referred to as the net monetary benefit. The value assigned to the QALY is based on the willingness to pay value chosen above. The treatment sequence with the greatest net monetary benefit can be considered the most cost-effective.

Next step

Value assessment approach #2: multi-criteria decision analysis

A criticism of cost-effectiveness analysis (CEA) is that it may not be able to incorporate all of the dimensions of treatment that are relevant to a decision-maker. An alternative approach to value assessment is multiple-criteria decision analysis (MCDA), which lets decision-makers weight different criteria (e.g., health outcomes, treatment attributes, costs) based on their importance to them.

MCDA works by converting performance on each of the included criteria to a single, common scale – in this case, a number between 0 and 100. Each one of the criteria is then given percentage weight that represents its importance relative to the other criteria, and these weights are then applied to arrive at a single weighted average score for each treatment sequence.

To see how this approach works, apply your own preference weights using the sliders for the criteria below.

Use the sliders to select the number of points (0-10) to assign to the criteria. Weights for each criterion (shown in the boxes to the right) are calculated by dividing each criterion's points by the sum of points across all criteria.

Overall value on 0-100 common scale

Probability ranked 1st

Note: The charts above report the mean results for each treatment sequence. The black bars indicate 95% credible intervals, or, the range of values in which the simulated mean values would lie with 95% probability. For a specific mean value and credible interval, hover your mouse over a bar above.

Next step

Explore how changing your perspective or assumptions affects estimates of value

The Outcomes and Value pages provide a starting point for understanding the relative value of RA therapies, but these results may fail to include factors that matter to some decision-makers. For example, insurers may focus on average health outcomes and medical costs across their population, patients may have preferences for treatments with certain attributes, and employers may be interested in effects on worker productivity. The interactive plots below allow you to explore how incorporating these different elements affect decision-making.

By allowing working-age patients to continue working, effective treatments can have important impacts on economic productivity.
Clinical trials and other studies may not capture all of the traits that are important to patients in decision-making. Two examples of traits identified by patients are below. Adjust the sliders below to see how these preferences affect MCDA based decisions.

Models usually report outcomes averaged across a population, but there are wide ranges in how patients respond to treatments. Select from the options below to see results for different levels of response.

By default, our model provides results for treatment of RA patients over their lifetimes, but decision-makers may be interested in value over a shorter timeframe. To adjust the timeframe for your results, move the slider below.

Medical therapies provide value to healthy people by reducing the risks posed by a future possible diagnosis of illness. In effect, knowing a therapy exists is like having flood insurance for your home – you might never need it, but you benefit from knowing you are protected.

Value based on CEA

Value based on MCDA

Value to the healthy

About the model

About the IVI-RA Value Tool

The IVI-RA Value Tool is a web application for assessing the value of disease-modifying anti-rheumatic drugs (DMARDs) for the treatment of moderate to severe rheumatoid arthritis (RA) developed as part of the Open-Source Value Project (OSVP). The OSVP is an open, collaborative, and consensus-driven process for developing open-source models for value assessment of medical interventions. The IVI-RA Value Tool is powered by the IVI-RA model, an open-source simulation model written in R and C++.

OSVP models, such as the IVI-RA model, are intended to serve as “laboratories” for engaging diverse stakeholders in constructive discussion about value assessment and improving the science of modeling and measuring value. There are many ways to provide feedback, make suggestions, and get involved in moving this work forward – see here for more information.

The OSVP is a project of the Innovation and Value Initiative (IVI). IVI is a collaboration among thought leaders in academia, patient advocacy organizations, payers, life sciences companies, providers, delivery systems and other organizations dedicated to preserving innovation, value, and choice in the healthcare system. Our mission is to improve the way value is measured and rewarded in the healthcare system, with the goal of promoting the development and use of high value interventions that advance health.

Contents of the IVI-RA modeling platform

The IVI-RA modeling platform consists of the following software in addition to the IVI-RA Value Tool:

  • The IVI-RA Model Interface Provides a dashboard interface for running analyses with the IVI-RA model, giving users control over all of the modeling parameters and structural assumptions.
  • The iviRA R package: The R package is for users who would like to fully customize their analyses.

Source code for the underlying model is available on GitHub.

How the IVI-RA model works

The IVI-RA model simulates the lifetime costs, health outcomes, and risks associated with sequences of disease-modifying anti-rheumatic drugs (DMARDs) including conventional DMARDs (cDMARDs), biologic DMARDs (bDMARDs), and Janus kinase/STAT pathway inhibitors. The primary measure of disease burden is the Health Assessment Questionnaire (HAQ) disability index, which is a measure of functional status among patients with RA. Patients with worse disability have lower quality-of-life, lower life expectancy, and are more likely to be hospitalized.

Detailed documentation of methods and sources of evidence is available here.

The patient population

Since the model simulates individual patients within a population, all results are conditional on the characteristics of the population considered. For example, simulated outcomes differ by gender, age, treatment histories, disease activity, and other factors. However, it is important to note that outcomes in the model are not reported for individual patients, but are averages across patients in the specified population.

In the IVI-RA Web Tool you can control age and gender, but other variables are set to their default values. Users who would like to fully customize their analysis should use the iviRA R package or the IVI-RA Model Interface.

Uncertainty analysis

There are many ways to build a value assessment model–what experts call structural uncertainty. And, there is always debate over the size and direction of key relationships in it –what experts call parameter uncertainty . Estimates of uncertainty in the IVI-RA Value Tool only account for parameter uncertainty and are based on probabilistic sensitivity analysis (PSA). Users can assess structural uncertainty by exploring any of the 384 model structures available in the iviRA R package and the IVI-RA Model Interface.

Currently, we use the following model structure in the IVI-RA Value Tool: (1) relationship between treatment and HAQ during the initial treatment phase based on Treatment -> ACR -> HAQ, (2) treatment switching during the initial treatment phase based on Treatment -> ACR -> Switch, (3) HAQ progression in the absence of cDMARDs based on the latent class growth model, (4) treatment discontinuation due to all causes using a generalized gamma distribution, and (5) use of the Hernandez-Alava (2013) mixture model.

Evidence considered

To ensure that simulated outcomes reflect outcomes in routine practice, baseline events rates (i.e., the rate of disease progression, the mortality rate, the rate at which patients discontinue treatment), patient preferences, and costs are modeled using real-world data. To enhance validity, relative treatment effects (e.g., relative risks, odds ratios, and hazard ratios) are, when possible, based on randomized clinical trials (RCTs).


The IVI-RA Value Tool is developed and maintained by Devin Incerti, Ming Xu, and Jeroen Jansen

Potential uses

How can you use the IVI-RA Value Tool?

One of the goals of the IVI-RA Value Tool (and the IVI-RA model more generally) is to inform decision-making. Health care decision-makers require high-quality evidence on treatment benefits and cost to make coverage decisions, negotiate prices, and make treatment decisions. The current version of the IVI-RA Value Tool is designed to support population-level decisions around how to best allocate limited health care dollars, but the information it provides is valuable to a wide range of stakeholders making many different kinds of decisions. For example:


How do I identify sources of health care spending that will provide the most value to society?
Spending on health care is often an investment with long-term returns, but understanding the broader benefits of health care spending decisions requires approaches that take a societal perspective. The IVI-RA Value Tool allows users to include societal-level treatment benefits and costs. Examples of these societal value components include productivity effects and benefits that healthy individuals obtain from medical technologies due to the reduced risks of physical harm (also called insurance value).


What is the value of RA treatments to my unique and specific enrollee population?
Health plans and insurers must make complex coverage decisions and negotiate prices that maximize benefits while minimizing cost across their enrolled populations. Every population of enrollees is unique, but information on value and cost-effectiveness is often presented for an “average” patient in the general population. The IVI-RA model provides full flexibility in defining population characteristics and adjusting inputs such as prices and rebates to tailor measures of value to a health plan’s unique set of enrollees.


How do my treatment decisions fit into value-based reimbursement?
As payers such as Medicare move towards value-based purchasing, provider compensation will increasingly depend on the quality and cost of the care they recommend. In this new value-based world, providers need to understand the relative benefits and costs of different treatment strategies at a practice level. The IVI-RA model synthesizes evidence sources to allow providers to examine the long-term health benefits and potential costs of different treatment strategies.

Life science firms

How do my product’s treatment benefits and costs compare to competitor treatments?
The IVI-RA model leverages evidence from both clinical trials and real world data to ensure that measures of treatment value are up-to-date and relevant to real-world clinical practice. Furthermore, in addition to using the IVI-RA Value Tool, life science firms can use the IVI-RA Model Interface, iviRA R package, or even customize the underlying source code, to run analyses that incorporate more recent evidence (e.g., recently released price changes, payer-specific rebates, more recent clinical trial data) between IVI model updates.


How do my own preferences impact the relative value of treatments for RA?
Rising drug prices and health care costs in the United States have generated discussions about paying for value rather than volume. At the same time, the value or cost-effectiveness of treatments may impact formulary decisions, prior authorization requirements, and other policies. In this context, the IVI-RA Value Tool can help patients and patient advocacy groups explore differences in value across treatments for RA. Moreover, as high-deductible health plans become more common, patients may want more information on whether a treatment is worth the cost.

Terms and conditions


These terms and conditions describe the terms and conditions applicable to your use of the Innovation and Value Initiative (“IVI”) website and Value Tool.



This website and the Value Tool are designed to provide information on value to a wide range of healthcare stakeholders, but not to be used as a clinical decision tool. Every effort has been made to provide the most current and correct information possible. Nonetheless, inadvertent technical inaccuracies or other errors may occur. IVI cannot be held responsible or liable for errors, inaccuracies, omissions or any perceived harm to users of this website or the Value Tool. Users of this information are encouraged to confirm the information contained herein with other sources. Any information is not intended to replace medical advice offered by healthcare providers. Use of this website or the Value Tool does not create a physician-patient relationship.




These terms and conditions may be modified at any time. Such modifications shall be effectively immediately. Your continued use of the IVI website or Value Tool shall constitute acknowledgement and acceptance of any such modifications.


IVI shall not be liable for any direct, indirect, consequential, special, exemplary, punitive, or any other monetary or other damages, fees, fines, penalties, or liabilities arising out of or related to this website, the Value Tool and/or information provided herein.


To the furthest extent permitted by law, you shall indemnify, defend, and hold harmless IVI and its members from any and all liabilities, claims, and causes of action (including all costs, expenses and attorney’s fees on account thereof) arising out of your use of the Value Tool, including but not limited to claims that IVI or its members were solely negligent or responsible for any harm, loss, or other liability relating to your use of the Value Tool.


The law of the State of New York shall govern these terms and conditions, without reference to its choice of law rules.


If any provision of these terms and conditions is held invalid or unenforceable by any court of competent jurisdiction, the other provisions of these terms and conditions shall remain in full force and effect.