Patient Advocates Say ICER Uses Discriminatory Cost MetricsJ
une 27, 2019
A coalition of patient advocates, provider groups and drug makers is criticizing the Institute for Clinical and Economic Review for using a metric they say discriminates against people with disabilities and chronic illness. ICER has responded to the criticism by saying it will include alternative, less controversial metrics in its cost-effectiveness reports.
The metric at issue is the Quality-Adjusted Life-Year, which is a commonly used standard internationally to determine the cost-effectiveness of medical treatments, including drugs. One QALY equals one year in perfect health.
Congress spurned the QALY metric when it restricted the partly government-funded Patient-Centered Outcomes Research Institute’s use of similar metrics in the Affordable Care Act.
“The Patient-Centered Outcomes Research Institute ... shall not develop or employ a dollars-per-quality adjusted life year (or similar measure that discounts the value of a life because of an individual’s disability) as a threshold to establish what type of health care is cost effective or recommended,” the law states.
Ari Ne’eman, a consultant and disability rights advocate, said he took issue with the QALY’s use of utility weights, or discounting the value of a year of life for patients who have chronic illness or disabilities.
Andrew Sperling, the director of federal legislative advocacy for the National Alliance on Mental Illness, said the National Health Council is developing alternatives to the QALY measure.
ICER calls the QALY “the gold standard” for measuring drugs’ value to patients in a statement made in December 2018, but it said future reports would add an alternative metric, the Equal Value of Life Years Gained, that measures gains of life equally regardless of conditions, age, severity of illness or disability.
“By highlighting the evLYG measure of health gain, we are responding to deeply held feelings expressed by some critics that the QALY could discriminate against vulnerable patient groups. We hope that raising the profile of the evLYG will reassure them and policymakers that when treatments offer the opportunity to extend lives, between the QALY and the evLYG we will make sure that each day, month, or year of extra life will be valued equally,” ICER President Steven Pearson said.
While the Partnership to Improve Patient Care--whose members include Pharmaceutical Research and Manufacturers of America and Biotechnology Innovation Organization -- is taking aim at ICER and insurers, it is not pushing a specific strategy to lower drug costs overall. PhRMA also posted its own blog this week calling for changes to ICER’s value assessment framework, including moving away from the QALY metric.
Sara van Geertruyden, executive director of the coalition, said tackling drug costs is a significant issue, but not the group’s current focus.
“The issue we are tackling today is making sure as we move down that path, that we don’t do it in a manner that discriminates against patients,” van Geertruyden said. -- Rachel Cohrs
An article in Inside Health Policy highlighted the Partnership to Improve Patient Care (PIPC) and Value Our Health's criticism of the Institute for Clinical and Economic Review's (ICER) use of the discriminatory quality-adjusted-life-year (QALY). The article astutely points out that the QALY metric has been spurned by Congress, restricting the Patient-Centered Outcomes Research Institute's (PCORI) use of the value assessment measures. The piece also amplifies PIPC's work in pushing for value assessments that incorporate patient preferences and don't utilize a one-size-fits-all approach. "The issue we are tackling today is making sure as we move down that path, that we don’t do it in a manner that discriminates against patients,” said PIPC Executive Director Sara van Geertruyden.
The article in its entirety can be read below.