ICER proposes updates to drug value analyses

By Sarah Chacko

The Institute for Clinical and Economic Review released proposed updates to it value assessment framework, which influences how much insurers pay for drugs, treatments and health services.

Drug companies and lobbyists have been critical of ICER's analyses, which attempt to set an independent pricing system that reflects all available data from drugmakers, insurers and patient groups.

The proposed updates improve the transparency and reproducibility of ICER’s economic models, formally add patient-centered factors into the framework, and considerably revise the institute’s approach to budget impact assessment, the National Pharmaceutical Council said in its initial review of the report.

Instead of trying to estimate the uptake of a new drug or service, ICER is proposing to use a range of potential product uptake rates and potential prices in its calculations. 

The new proposed structure of the ICER value framework requires consideration of two general concepts — long-term value for money and short-term affordability.

New terms and measures.

Long-term value for money — the “primary anchor” of ICER’s value analysis — would replace “care value” as the term for the evaluation of clinical effectiveness, incremental cost-effectiveness, other benefits or disadvantages, and contextual considerations, such as the severity of a condition or if other treatments are available or soon will be.

The primary measure for incremental cost-effectiveness will remain the cost per quality-adjusted life year (QALY) — a globally recognized standard for capturing longer life or improved quality of life benefits. 

ICER is proposing to expand its cost-effectiveness range to make $50,000 per QALY the lower bound, which is currently $100,000 per QALY, and maintain $150,000 as an upper limit. 

ICER also proposed weighting other benefits or disadvantages and contextual considerations given by an independent appraisal committee, and including in its future reports the analyses of cost per life-year gained and certain other “cost per consequences” when relevant. 

For example, treatments intended to prevent strokes might be compared by a “cost per stroke averted” analysis along with the cost per QALY analysis, the report says.

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