PIPC Chairman, Patient Advocate
Proposals for Medicare and private payers to use CER are understandable, but concerning. Understandable because the challenge of rising costs is real, and policy-makers naturally reach for familiar policy tools. Concerning because it would pull CER away from individualized patient decisions and back towards centralized payer decisions. The end result would be limited choice of treatments based on one-size-fits-all determinations of 'value' for the average patient.
American Society for Clinical Oncology
There are significant limitations to the application of QALYs, because individuals with the same illness may have different preferences for a health state. For example, one individual with advanced cancer may prefer length of overall survival (OS) above all else, whereas another might view minimization of symptoms as the highest priority.
Currently, no uniform [cost-effectiveness] threshold exists across health care systems; however, in many countries, such thresholds are being established, which raises concerns about limiting patient choice and health care rationing.
Former CMS Official
Even though well-conducted comparative effectiveness studies can show that one treatment is superior to another overall, that does not rule out the potential that there are a number of patients who will probably respond to the technology that's less effective…If we made a decision that we would not pay for the thing that's less effective, we in fact could be creating harm.
Testimony to Ways and Means Committee
AARP cautions against using comparative effectiveness information simply for cost-effectiveness or coverage determinations, particularly in the Medicare context. We do not believe this is an appropriate step at this time. Comparative effectiveness is intended to help consumers and providers determine the best treatment – not just the least costly treatment.