In This Week’s Issue:
1. PIPC Comments on PCORI Proposed National Priorities for Health, click here to read the letter.
2. PCORI Announces Engagement Award on Consideration of the Full Range of Outcomes Data, see details below.
3. New Funding Opportunities Open September 7th. Click here to read more.
4. New Disability Equity Collaborative Paper Identifies Research Priorities for Advancing Equitable Care for People with Disabilities. Click here to read the press release.
5. PIPC Submits Comment Letter to ICER on Draft Evidence Report for Myasthenia Gravis. Click here to read the letter.
6. It is Time to Let Go of the QALY’s Legacy of Discrimination. Click here to read the article.
7. Value Assessment in the News, see details below.
8. Announcing the Disability Equity Collaborative. Click here to visit the new website.
9. Is the QALY Fit for Purpose? Click here to read the journal.
10. 2021 PCORI Annual Meeting Scheduled for Nov. 17-19, click here for details.
11. International News: What Happens in Countries Using QALYs and Cost-Based Thresholds to Determine Coverage? See below for more.
12. Emerging Threats in States for Use of Discriminatory Metrics, see details below.
13. IVI to Hold Second Methods Summit, click here to learn more.
14. ICER's QALY-Based Study Topics: Hypertrophic Cardiomyopathy, Myasthenia Gravis, Atopic Dermatitis, Alzheimer's Disease, Asthma, Type 2 Diabetes, click here to provide patient input.
15. Upcoming Events and Webinars, see details below.
16. Medical Journal Articles, see details below.
17. AHRQ Effective Program Updates, see details below.
1. PIPC Comments on PCORI Proposed National Priorities for Health, click here to read the letter.
2. PCORI Announces Engagement Award on Consideration of the Full Range of Outcomes Data, see details below.
3. New Funding Opportunities Open September 7th. Click here to read more.
4. New Disability Equity Collaborative Paper Identifies Research Priorities for Advancing Equitable Care for People with Disabilities. Click here to read the press release.
5. PIPC Submits Comment Letter to ICER on Draft Evidence Report for Myasthenia Gravis. Click here to read the letter.
6. It is Time to Let Go of the QALY’s Legacy of Discrimination. Click here to read the article.
7. Value Assessment in the News, see details below.
8. Announcing the Disability Equity Collaborative. Click here to visit the new website.
9. Is the QALY Fit for Purpose? Click here to read the journal.
10. 2021 PCORI Annual Meeting Scheduled for Nov. 17-19, click here for details.
11. International News: What Happens in Countries Using QALYs and Cost-Based Thresholds to Determine Coverage? See below for more.
12. Emerging Threats in States for Use of Discriminatory Metrics, see details below.
13. IVI to Hold Second Methods Summit, click here to learn more.
14. ICER's QALY-Based Study Topics: Hypertrophic Cardiomyopathy, Myasthenia Gravis, Atopic Dermatitis, Alzheimer's Disease, Asthma, Type 2 Diabetes, click here to provide patient input.
15. Upcoming Events and Webinars, see details below.
16. Medical Journal Articles, see details below.
17. AHRQ Effective Program Updates, see details below.
1. PIPC Comments on PCORI Proposed National Priorities for Health
In a comment letter to the Patient-Centered Outcomes Research Institute (PCORI), the Partnership to Improve Patient Care (PIPC) offered feedback on PCORI's Proposed National Priorities for Health.
The letter encourages PCORI work closely with stakeholders in identifying the topics to be prioritized within each broad area, the research agenda for each topic, and the outcomes data to be collected and analyzed as part of the research. PIPC also reiterated its strong support for PCORI’s mandate of conducting research on the comparative clinical effectiveness of medical treatments and services, as well as the statutory prohibition against cost- effectiveness analysis.
2. PCORI Announces Engagement Award on Consideration of the Full Range of Outcomes Data
As a component of PCORI’s reauthorization, a provision was included requiring PCORI-funded research to consider the full range of outcomes data, including potential burdens and economic impacts. PCORI has adopted principles for collecting this data. As PCORI moves forward in this process, it is accepting applications for Engagement Awards to fund convenings focused on defining appropriate and relevant burdens and economic impact data, identifying sources of and gaps in data, and opportunities to advance the rigor and standards when conducting research that considers a full range of outcomes data. PCORI will play an important role in defining what factors on cost and economic burden are important to the individuals our healthcare system serves and how to collect this data in a rigorous and patient-centric manner. Organizations wishing to apply for these Engagement Awards may do so here.
3. New Funding Opportunities Open Today
On September 7, PCORI will begin accepting applications through our Phased Large Awards for Comparative Effectiveness Research (PLACER) PCORI Funding Announcement (PFA) totaling up to $200 million. This PFA offers funds to support large, multiphase comparative clinical effectiveness research (CER) studies designed to fill critical gaps in evidence and support healthcare decision making.
PCORI is also accepting applications through several Broad PFAs for CER studies aligned with our current National Priorities, offering a cumulative total of $72 million. Within these opportunities, new special areas of focus will include telehealth for chronic disease management among vulnerable populations and addressing systemic racism, discrimination, and bias in healthcare systems and healthcare delivery. Prospective applicants are invited to attend a September 8 town hall for more information.
4. New DEC Paper Identifies Research Priorities for Advancing Equitable Care for People with Disabilities.
A research workgroup of the Disability Equity Collaborative (DEC) released its first paper, "Patient-Centered Outcomes Research Priorities to Advance Disability Equity" funded by the Patient-Centered Outcomes Research Institute (PCORI). The publication provides a clear, much needed blueprint for the field, identifying critical areas for research, providing guidance for funding agencies, and outlining gaps that policy makers need to address to assure equitable health care for people with disabilities. Click here to read the white paper.
5. PIPC Submits Comment Letter to ICER on Draft Evidence Report for Myasthenia Gravis
In a comment letter to the Institute for Clinical and Economic Review (ICER), the Partnership to Improve Patient Care (PIPC) offered feedback on ICER’s draft evidence report for Myasthenia Gravis (MG). =PIPC offered strong criticism of ICER’s model for its use of the discriminatory quality-adjusted-life-years (QALY) metric. The letter also highlights additional flaws in ICER’s report, including: (1) failing to accurately capture patient heterogeneity; (2) inaccurately capturing the MG patient experience; and (3) misrepresenting hospitalization costs for MG patients.
6. It is Time to Let Go of the QALY's Legacy of Discrimination
In a piece published by The Center for Dignity in Healthcare for People with Disabilities, authors Kelly Israel of Autistic Self Advocacy Network and Sara van Geertruyden of PIPC explain the Quality-Adjusted Life Year (QALY), how it is used, and its discriminatory implications. The authors explain the politics of the QALY as well as some of the challenges we face as we try to move beyond this discriminatory metric. Ultimately they conclude that investment is needed to develop methods to assess values of treatments that do not discriminate and sustained advocacy is needed to remind states and other entities of their obligations of nondiscrimination under the ADA and other disability rights laws. Click here to read the full article.
7. Value Assessment in the News
Federal policymakers are considering value assessment options, from domestic reference pricing to foreign reference pricing. As policymakers consider alternatives to QALYs and the evLYG which is derived from a QALY, it is important that policymakers to understand value assessment, how discriminatory metrics are used in value assessment and how innovators like PCORI and IVI are developing new methods for assessing cost and economic data related to care and treatment. For more information about evLYG, please view this PIPC Chairman blog and this Twitter thread that explains the evLYG method in more detail. We urge you to share widely the concerns from the National Council on Disability related to QALYs and evLYG (p. 61) and CBO’s use of QALYs to score H.R. 3 as a reminder that patients and people with disabilities oppose the use of this metric and metrics related to it like evLYG. Click here to view principles for value assessment centered on patients and people with disabilities.
8. Announcing the Disability Equity Collaborative
The University of Colorado Anschutz has recently formalized the Disability Equity Collaborative (DEC) with support from an engagement award from PCORI. DEC is the nation’s leading organization providing evidence-based knowledge and practical solutions and tools to address accessible healthcare for persons with disabilities. DEC and its partners are committed to developing meaningful, practical solutions to ensure access to equitable, high quality health care for all people. Learn more about DEC here and sign up to receive more information from DEC.
9. AJMC: Is the QALY Fit for Purpose?
The American Journal of Managed Care (AJMC) published a journal article that examines some of the flaws of the quality-adjusted-life-years metric. "We argue that the QALY does not currently pass these 3 tests to an acceptable standard," the authors write. "We argue for methods to achieve incremental improvement in both the scientific and ethical standards used in constructing measures such as the QALY and for an end to the inertia in improving a measurement system that is widely considered inadequate." Click here to read the journal.
10. 2021 PCORI Annual Meeting Scheduled for Nov. 17-19
In a comment letter to the Patient-Centered Outcomes Research Institute (PCORI), the Partnership to Improve Patient Care (PIPC) offered feedback on PCORI's Proposed National Priorities for Health.
The letter encourages PCORI to use its new authority to collect and analyze cost and economic data as a catalyst for developing standards that will assure the information collected represents methods that are rigorous and centered on preferences, needs, and outcomes that matter to patients and people with disabilities. PIPC also urged PCORI work closely with stakeholders in identifying the topics to be prioritized within each broad area, the research agenda for each topic, and the outcomes data to be collected and analyzed as part of the research. PIPC also reiterated its strong support for PCORI’s mandate of conducting research on the comparative clinical effectiveness of medical treatments and services, as well as the statutory prohibition against cost- effectiveness analysis.
11. International News: What Happens in Countries Using QALYs and Cost-Based Thresholds to Determine Coverage?
Other countries are often referenced as examples of how the use of QALYs or similar cost-based thresholds impact access to care.
12. Emerging Threats in States for Use of Discriminatory Metrics
Several states are considering policies that would reference entities such as the Institute for Clinical and Economic Review (ICER), which calls the discriminatory quality-adjusted life year (QALY) the “gold standard” for value assessment, and others are considering policies to import QALY-based coverage and reimbursement decisions from other countries that restrict access to care. Yet, federal policymakers have emphasized that the use of discriminatory metrics is subject to civil rights laws such as the Americans with Disabilities Act. We encourage sharing resources for advocates in key states mentioned below to ensure protections against discrimination!
Other states to watch: Rhode Island, Minnesota and Washington State are also potential targets for future legislation that could trigger the use of discriminatory QALYs through creation of a Board or commission that informs state Medicaid coverage and reimbursement decisions.
Virginia
Efforts are underway to advance legislation that would create a Prescription Drug Affordability Board in the State of Virginia, triggering concerns about potential discrimination, according to recent news. It is not clear that these efforts will include provisions to bar discrimination and protect patient access to medications, such as achieved by disability advocates in other states such as Oregon where the legislature barred the use of QALYs in similar Board deliberations.
New Mexico
Renewed efforts are anticipated in New Mexico to advance legislation creating a Prescription Drug Affordability Board, triggering concerns about potential discrimination. It is not clear that these efforts will include provisions to bar discrimination and protect patient access to medications, such as achieved by disability advocates in other states. The news about the effort has not mentioned including a ban on the use of discriminatory QALYs nor including patient and disability representation or other patient protections from restricted access to care.
Maryland
The Maryland legislature passed legislation earlier this year creating a Prescription Drug Affordability Board. The legislation did not include protections for patients and people with disabilities such as barring the use of discriminatory QALYs. The Board has begun meeting to hear from stakeholders, including hearing a presentation from the Institute for Clinical and Economic Review which relies on QALYs to assess treatment value. Legislation was introduced this year to bar the use of QALYs and implement patient protections that has not advanced in the legislature. On August 3, organizations representing patients and people with disabilities sent a letter urging the Board to avoid policies that would potentially discriminate by relying on discriminatory metrics such as QALYs.
Colorado
The Governor of Colorado has signed into law SB 21-175, which creates a prescription drug affordability review board. SB 21-75 did include an amendment that prohibits the use of QALYs in the section of the bill that determines an upper payment limit. In some states these types of boards and commissions have referenced value assessments based on QALYs from the Institute for Clinical and Economic Review (ICER). In Massachusetts, the Health Policy Commission went so far as to contract with ICER. In order to mitigate this, it is important that the Board has representation from patients and people with disabilities. The Governors office is accepting applications for both the Colorado Prescription Drug Affordability Review Board and the Colorado Prescription Drug Affordability Advisory Council. It is essential that the Board and Advisory Committee include representation from patients and people with disabilities to ensure that that the Board’s deliberations do not include consideration of QALYs and other metrics that may discriminate or lead to restricted access for people with disabilities and chronic conditions or older adults.
Massachusetts
The Massachusetts House and Senate have each taken the positive step of introducing An Act Advancing Health Care Research and Decision-Making Centered on Patients and People with Disabilities, H.201 and S.753. This bill would enshrine essential patient protections including a ban on the use of the QALY, a requirement for research to meet patient-centeredness criteria, and robust engagement of the patient and disability communities in health care decision making.
California
CA AB 1130, the California Health Care Quality and Affordability Act, is being considered in California to create an Office of Health Care Affordability. Similar to the Massachusetts Health Policy Commission, the legislation would authorize reviewing health costs and "require the office to set priority standards for various health care metrics.” In Massachusetts, the Health Policy Commission went so far as to contract with ICER. This language was originally proposed by Governor Gavin Newsom in the California Budget for 2021-22 which included a proposal for a new Office of Health Care Affordability to be housed within the Office of Statewide Health Planning and Development (OSHPD) that would seek to promote “cost efficient” care. It is anticipated that this will be advanced as part of the California budget. The Value Our Health template language has not been introduced or passed in California to protect patients from the use of QALYs and discriminatory considerations of cost effectiveness. Patient groups sent a letter to a CA State Assembly member and a letter to committee and subcommittee chairs urging them to avoid policies that would potentially discriminate by relying on discriminatory metrics such as QALYs.
13. IVI to Hold Second Methods Summit
The Innovation and Value Initiative (IVI) announced that it will hold a second methods summit to drive patient-centered value assessment. The multi-stakeholder event is intended to drive consensus on priority patient inputs, methods, and research that more fully represent the patient perspective in comparative effectiveness research and economic evaluations of health care interventions. The three-part series will take place in Fall 2021. Overall, the goal of IVI’s summit is to define an action agenda for patient-centered outcomes research and cost-effectiveness research by exploring patient outcomes, beyond traditional clinical factors, that represent important impacts to patients and must be accounted for in economic analyses. Click here to learn more.
14. ICER's QALY-Based Study Topics: Hypertrophic Myocardiopathy, Myasthenia Gravis, Atopic Dermatitis, Alzheimer's Disease, Asthma, Type 2 Diabetes
The Institute for Clinical Economic Review (ICER) conducts cost effectiveness studies for insurers using the cost-per-QALY methodology. ICER provides guidance on its website for patients and patient advocates to provide direct input related to their experiences with the disease. Click here to provide patient input. Click here to view the topics and deadlines.
15. Upcoming Events and Webinars
Cycle 3 2021 -- Broad PCORI Funding Announcement Applicant Town Hall
September 8, 2021
Click here to view.
Whistleblowers of America: Workplace Promise Institute 2021 Conference
September 9-10, 2021
Click here to view.
Cycle 3 2021 -- Phased Large Awards for Comparative Effectiveness Research (PLACER) Applicant Town Hall
September 10, 2021
Click here to view.
PCORI Annual Meeting
November 17-19, 2021
Click here to view.
16. Medical Journal Articles
Evaluation of Financial Outcomes Under a Value-Based Payment Program for Community Pharmacies, click here to view.
Limited Role of Patient Input in Specialty Drug Coverage Policies, click here to view.
The Importance of Collaboration in Pursuit of Patient-Centered Value Assessment, click here to view.
Toward Better Data Dashboards for US Drug Value Assessments, click here to view.
Prevalence of Avoidable and Bias-Inflicting Methodological Pitfalls in Real-World Studies of Medication Safety and Effectiveness, click here to view.
Association of Co-Pay Elimination With Medication Adherence and Total Cost, click here to view.
The Utility of Patient Engagement in Drug Research and Development, click here to view.
Patient-Powered Research Networks of the Autoimmune Research Collaborative: Rationale, Capacity, and Future Directions, click here to view.
Enhancing Patient Research Partner Engagement: Research in Psoriatic Arthritis, click here to view.
Patient Voices in Value-Based Cancer Care: Priorities for the Biden Administration, click here to view.
The Dollar or Disease Burden: Caps on Healthcare Spending May Save Money, but at What “Cost” to Patients?, click here to view.
17. AHRQ Effective Program Updates
Systematic Review: Interventional Treatments for Acute and Chronic Pain. Click here to view.
Research Protocol: Creating Efficiencies in the Extraction of Data From Randomized Trials: A Prospective Evaluation of a Machine Learning and Text Mining Tool. Click here to view.
Research Protocol: Schedule of Visits and Use of Telemedicine for Routine Antenatal Care. Click here to view.
Systematic Review: Breast Reconstruction After Mastectomy, click here to view.
Surveillance Report: Living Systematic Review on Cannabis and Other Plant-Based Treatments for Chronic Pain. Click here to view.
Systematic Review: Prehospital Airway Management. Click here to view.
Systematic Review: Radiation Therapy for Brain Metastases. Click here to view.
Systematic Review: Safety of Vaccines Used for Routine Immunization in the United States: An Update. Click here to view.
Research Protocol: Evaluation of Mental Health Applications. Click here to view.
Maternal, Fetal, and Child Outcomes of Mental Health Treatments in Women: A Systematic Review of Perinatal Pharmacologic Interventions. Click here to view.
In a comment letter to the Patient-Centered Outcomes Research Institute (PCORI), the Partnership to Improve Patient Care (PIPC) offered feedback on PCORI's Proposed National Priorities for Health.
The letter encourages PCORI work closely with stakeholders in identifying the topics to be prioritized within each broad area, the research agenda for each topic, and the outcomes data to be collected and analyzed as part of the research. PIPC also reiterated its strong support for PCORI’s mandate of conducting research on the comparative clinical effectiveness of medical treatments and services, as well as the statutory prohibition against cost- effectiveness analysis.
2. PCORI Announces Engagement Award on Consideration of the Full Range of Outcomes Data
As a component of PCORI’s reauthorization, a provision was included requiring PCORI-funded research to consider the full range of outcomes data, including potential burdens and economic impacts. PCORI has adopted principles for collecting this data. As PCORI moves forward in this process, it is accepting applications for Engagement Awards to fund convenings focused on defining appropriate and relevant burdens and economic impact data, identifying sources of and gaps in data, and opportunities to advance the rigor and standards when conducting research that considers a full range of outcomes data. PCORI will play an important role in defining what factors on cost and economic burden are important to the individuals our healthcare system serves and how to collect this data in a rigorous and patient-centric manner. Organizations wishing to apply for these Engagement Awards may do so here.
3. New Funding Opportunities Open Today
On September 7, PCORI will begin accepting applications through our Phased Large Awards for Comparative Effectiveness Research (PLACER) PCORI Funding Announcement (PFA) totaling up to $200 million. This PFA offers funds to support large, multiphase comparative clinical effectiveness research (CER) studies designed to fill critical gaps in evidence and support healthcare decision making.
PCORI is also accepting applications through several Broad PFAs for CER studies aligned with our current National Priorities, offering a cumulative total of $72 million. Within these opportunities, new special areas of focus will include telehealth for chronic disease management among vulnerable populations and addressing systemic racism, discrimination, and bias in healthcare systems and healthcare delivery. Prospective applicants are invited to attend a September 8 town hall for more information.
4. New DEC Paper Identifies Research Priorities for Advancing Equitable Care for People with Disabilities.
A research workgroup of the Disability Equity Collaborative (DEC) released its first paper, "Patient-Centered Outcomes Research Priorities to Advance Disability Equity" funded by the Patient-Centered Outcomes Research Institute (PCORI). The publication provides a clear, much needed blueprint for the field, identifying critical areas for research, providing guidance for funding agencies, and outlining gaps that policy makers need to address to assure equitable health care for people with disabilities. Click here to read the white paper.
5. PIPC Submits Comment Letter to ICER on Draft Evidence Report for Myasthenia Gravis
In a comment letter to the Institute for Clinical and Economic Review (ICER), the Partnership to Improve Patient Care (PIPC) offered feedback on ICER’s draft evidence report for Myasthenia Gravis (MG). =PIPC offered strong criticism of ICER’s model for its use of the discriminatory quality-adjusted-life-years (QALY) metric. The letter also highlights additional flaws in ICER’s report, including: (1) failing to accurately capture patient heterogeneity; (2) inaccurately capturing the MG patient experience; and (3) misrepresenting hospitalization costs for MG patients.
6. It is Time to Let Go of the QALY's Legacy of Discrimination
In a piece published by The Center for Dignity in Healthcare for People with Disabilities, authors Kelly Israel of Autistic Self Advocacy Network and Sara van Geertruyden of PIPC explain the Quality-Adjusted Life Year (QALY), how it is used, and its discriminatory implications. The authors explain the politics of the QALY as well as some of the challenges we face as we try to move beyond this discriminatory metric. Ultimately they conclude that investment is needed to develop methods to assess values of treatments that do not discriminate and sustained advocacy is needed to remind states and other entities of their obligations of nondiscrimination under the ADA and other disability rights laws. Click here to read the full article.
7. Value Assessment in the News
Federal policymakers are considering value assessment options, from domestic reference pricing to foreign reference pricing. As policymakers consider alternatives to QALYs and the evLYG which is derived from a QALY, it is important that policymakers to understand value assessment, how discriminatory metrics are used in value assessment and how innovators like PCORI and IVI are developing new methods for assessing cost and economic data related to care and treatment. For more information about evLYG, please view this PIPC Chairman blog and this Twitter thread that explains the evLYG method in more detail. We urge you to share widely the concerns from the National Council on Disability related to QALYs and evLYG (p. 61) and CBO’s use of QALYs to score H.R. 3 as a reminder that patients and people with disabilities oppose the use of this metric and metrics related to it like evLYG. Click here to view principles for value assessment centered on patients and people with disabilities.
8. Announcing the Disability Equity Collaborative
The University of Colorado Anschutz has recently formalized the Disability Equity Collaborative (DEC) with support from an engagement award from PCORI. DEC is the nation’s leading organization providing evidence-based knowledge and practical solutions and tools to address accessible healthcare for persons with disabilities. DEC and its partners are committed to developing meaningful, practical solutions to ensure access to equitable, high quality health care for all people. Learn more about DEC here and sign up to receive more information from DEC.
9. AJMC: Is the QALY Fit for Purpose?
The American Journal of Managed Care (AJMC) published a journal article that examines some of the flaws of the quality-adjusted-life-years metric. "We argue that the QALY does not currently pass these 3 tests to an acceptable standard," the authors write. "We argue for methods to achieve incremental improvement in both the scientific and ethical standards used in constructing measures such as the QALY and for an end to the inertia in improving a measurement system that is widely considered inadequate." Click here to read the journal.
10. 2021 PCORI Annual Meeting Scheduled for Nov. 17-19
In a comment letter to the Patient-Centered Outcomes Research Institute (PCORI), the Partnership to Improve Patient Care (PIPC) offered feedback on PCORI's Proposed National Priorities for Health.
The letter encourages PCORI to use its new authority to collect and analyze cost and economic data as a catalyst for developing standards that will assure the information collected represents methods that are rigorous and centered on preferences, needs, and outcomes that matter to patients and people with disabilities. PIPC also urged PCORI work closely with stakeholders in identifying the topics to be prioritized within each broad area, the research agenda for each topic, and the outcomes data to be collected and analyzed as part of the research. PIPC also reiterated its strong support for PCORI’s mandate of conducting research on the comparative clinical effectiveness of medical treatments and services, as well as the statutory prohibition against cost- effectiveness analysis.
11. International News: What Happens in Countries Using QALYs and Cost-Based Thresholds to Determine Coverage?
Other countries are often referenced as examples of how the use of QALYs or similar cost-based thresholds impact access to care.
- Australia: Many CF patients are suffering without access to Trikafta because PBS will not allow everyone to receive access to the life-saving drug.
- Canada: CF patients and advocates are pushing the Ontario government to provide funding to Trikafta, a life-saving drug.
- New Zealand: SMA advocates are enraged with Pharmac’s approach to ranking the funding priority of life-saving medications, as they allow entire staff to join confidential meetings.
12. Emerging Threats in States for Use of Discriminatory Metrics
Several states are considering policies that would reference entities such as the Institute for Clinical and Economic Review (ICER), which calls the discriminatory quality-adjusted life year (QALY) the “gold standard” for value assessment, and others are considering policies to import QALY-based coverage and reimbursement decisions from other countries that restrict access to care. Yet, federal policymakers have emphasized that the use of discriminatory metrics is subject to civil rights laws such as the Americans with Disabilities Act. We encourage sharing resources for advocates in key states mentioned below to ensure protections against discrimination!
- Click here to learn more about the potential for Prescription Drug Affordability Boards to discriminate by incorporating the use of QALYS.
- Click here to view the Value Our Health state template legislation that would protect people with disabilities and chronic conditions from the use of QALYs and similar metrics developed by third parties such as ICER in decisions related to reimbursement and coverage, as well as ensure their engagement in decision-making.
- Click here to view a one pager about the flaws in ICER’s methodology.
- Click here to view information from experts on the downside of referencing foreign countries.
- Click here to learn about statutory protections against use of QALYs.
Other states to watch: Rhode Island, Minnesota and Washington State are also potential targets for future legislation that could trigger the use of discriminatory QALYs through creation of a Board or commission that informs state Medicaid coverage and reimbursement decisions.
Virginia
Efforts are underway to advance legislation that would create a Prescription Drug Affordability Board in the State of Virginia, triggering concerns about potential discrimination, according to recent news. It is not clear that these efforts will include provisions to bar discrimination and protect patient access to medications, such as achieved by disability advocates in other states such as Oregon where the legislature barred the use of QALYs in similar Board deliberations.
New Mexico
Renewed efforts are anticipated in New Mexico to advance legislation creating a Prescription Drug Affordability Board, triggering concerns about potential discrimination. It is not clear that these efforts will include provisions to bar discrimination and protect patient access to medications, such as achieved by disability advocates in other states. The news about the effort has not mentioned including a ban on the use of discriminatory QALYs nor including patient and disability representation or other patient protections from restricted access to care.
Maryland
The Maryland legislature passed legislation earlier this year creating a Prescription Drug Affordability Board. The legislation did not include protections for patients and people with disabilities such as barring the use of discriminatory QALYs. The Board has begun meeting to hear from stakeholders, including hearing a presentation from the Institute for Clinical and Economic Review which relies on QALYs to assess treatment value. Legislation was introduced this year to bar the use of QALYs and implement patient protections that has not advanced in the legislature. On August 3, organizations representing patients and people with disabilities sent a letter urging the Board to avoid policies that would potentially discriminate by relying on discriminatory metrics such as QALYs.
Colorado
The Governor of Colorado has signed into law SB 21-175, which creates a prescription drug affordability review board. SB 21-75 did include an amendment that prohibits the use of QALYs in the section of the bill that determines an upper payment limit. In some states these types of boards and commissions have referenced value assessments based on QALYs from the Institute for Clinical and Economic Review (ICER). In Massachusetts, the Health Policy Commission went so far as to contract with ICER. In order to mitigate this, it is important that the Board has representation from patients and people with disabilities. The Governors office is accepting applications for both the Colorado Prescription Drug Affordability Review Board and the Colorado Prescription Drug Affordability Advisory Council. It is essential that the Board and Advisory Committee include representation from patients and people with disabilities to ensure that that the Board’s deliberations do not include consideration of QALYs and other metrics that may discriminate or lead to restricted access for people with disabilities and chronic conditions or older adults.
Massachusetts
The Massachusetts House and Senate have each taken the positive step of introducing An Act Advancing Health Care Research and Decision-Making Centered on Patients and People with Disabilities, H.201 and S.753. This bill would enshrine essential patient protections including a ban on the use of the QALY, a requirement for research to meet patient-centeredness criteria, and robust engagement of the patient and disability communities in health care decision making.
California
CA AB 1130, the California Health Care Quality and Affordability Act, is being considered in California to create an Office of Health Care Affordability. Similar to the Massachusetts Health Policy Commission, the legislation would authorize reviewing health costs and "require the office to set priority standards for various health care metrics.” In Massachusetts, the Health Policy Commission went so far as to contract with ICER. This language was originally proposed by Governor Gavin Newsom in the California Budget for 2021-22 which included a proposal for a new Office of Health Care Affordability to be housed within the Office of Statewide Health Planning and Development (OSHPD) that would seek to promote “cost efficient” care. It is anticipated that this will be advanced as part of the California budget. The Value Our Health template language has not been introduced or passed in California to protect patients from the use of QALYs and discriminatory considerations of cost effectiveness. Patient groups sent a letter to a CA State Assembly member and a letter to committee and subcommittee chairs urging them to avoid policies that would potentially discriminate by relying on discriminatory metrics such as QALYs.
13. IVI to Hold Second Methods Summit
The Innovation and Value Initiative (IVI) announced that it will hold a second methods summit to drive patient-centered value assessment. The multi-stakeholder event is intended to drive consensus on priority patient inputs, methods, and research that more fully represent the patient perspective in comparative effectiveness research and economic evaluations of health care interventions. The three-part series will take place in Fall 2021. Overall, the goal of IVI’s summit is to define an action agenda for patient-centered outcomes research and cost-effectiveness research by exploring patient outcomes, beyond traditional clinical factors, that represent important impacts to patients and must be accounted for in economic analyses. Click here to learn more.
14. ICER's QALY-Based Study Topics: Hypertrophic Myocardiopathy, Myasthenia Gravis, Atopic Dermatitis, Alzheimer's Disease, Asthma, Type 2 Diabetes
The Institute for Clinical Economic Review (ICER) conducts cost effectiveness studies for insurers using the cost-per-QALY methodology. ICER provides guidance on its website for patients and patient advocates to provide direct input related to their experiences with the disease. Click here to provide patient input. Click here to view the topics and deadlines.
- Type 2 Diabetes: Draft Scoping Document and Research Protocol available. 11/09/21: Draft Evidence Report. Meeting 1/20/2022: Deliberation and vote on evidence presented in ICER's report on therapies for Type 2 Diabetes
- Hypertrophic Cardiomyopathy: Draft Evidence Report available. Public Comments open through 9/15/2021. Meeting 10/22/2021: CTAF will deliberate and vote on evidence presented in ICER’s report on therapies for obstructive hypertrophic cardiomyopathy.
- Myasthenia Gravis: Draft Evidence Report available - Comments closed. Meeting 9/24/2021: New England CEPAC will deliberate and vote on evidence presented in ICER’s report on therapies for myasthenia gravis.
- Atopic Dermatitis: Meeting with New England CEPAC was held 7/23/2021. Final Evidence Report available.
- Hereditary Angioedema: RWE Update: Final updated assessment released 8/23/2021.
- Unsupported Price Increase: 11/16/2021: Final Report.
- Asthma: Model Analysis Plan available. 9/16/2021: Draft Evidence Report. Meeting 11/19/2021: New England CEPAC will deliberate and vote on evidence presented in ICER’s report on therapies for severe asthma.
- Fair Access: Coverage Policies in 2020: Protocol Available. 10/20/2021: Final Report.
15. Upcoming Events and Webinars
Cycle 3 2021 -- Broad PCORI Funding Announcement Applicant Town Hall
September 8, 2021
Click here to view.
Whistleblowers of America: Workplace Promise Institute 2021 Conference
September 9-10, 2021
Click here to view.
Cycle 3 2021 -- Phased Large Awards for Comparative Effectiveness Research (PLACER) Applicant Town Hall
September 10, 2021
Click here to view.
PCORI Annual Meeting
November 17-19, 2021
Click here to view.
16. Medical Journal Articles
Evaluation of Financial Outcomes Under a Value-Based Payment Program for Community Pharmacies, click here to view.
Limited Role of Patient Input in Specialty Drug Coverage Policies, click here to view.
The Importance of Collaboration in Pursuit of Patient-Centered Value Assessment, click here to view.
Toward Better Data Dashboards for US Drug Value Assessments, click here to view.
Prevalence of Avoidable and Bias-Inflicting Methodological Pitfalls in Real-World Studies of Medication Safety and Effectiveness, click here to view.
Association of Co-Pay Elimination With Medication Adherence and Total Cost, click here to view.
The Utility of Patient Engagement in Drug Research and Development, click here to view.
Patient-Powered Research Networks of the Autoimmune Research Collaborative: Rationale, Capacity, and Future Directions, click here to view.
Enhancing Patient Research Partner Engagement: Research in Psoriatic Arthritis, click here to view.
Patient Voices in Value-Based Cancer Care: Priorities for the Biden Administration, click here to view.
The Dollar or Disease Burden: Caps on Healthcare Spending May Save Money, but at What “Cost” to Patients?, click here to view.
17. AHRQ Effective Program Updates
Systematic Review: Interventional Treatments for Acute and Chronic Pain. Click here to view.
Research Protocol: Creating Efficiencies in the Extraction of Data From Randomized Trials: A Prospective Evaluation of a Machine Learning and Text Mining Tool. Click here to view.
Research Protocol: Schedule of Visits and Use of Telemedicine for Routine Antenatal Care. Click here to view.
Systematic Review: Breast Reconstruction After Mastectomy, click here to view.
Surveillance Report: Living Systematic Review on Cannabis and Other Plant-Based Treatments for Chronic Pain. Click here to view.
Systematic Review: Prehospital Airway Management. Click here to view.
Systematic Review: Radiation Therapy for Brain Metastases. Click here to view.
Systematic Review: Safety of Vaccines Used for Routine Immunization in the United States: An Update. Click here to view.
Research Protocol: Evaluation of Mental Health Applications. Click here to view.
Maternal, Fetal, and Child Outcomes of Mental Health Treatments in Women: A Systematic Review of Perinatal Pharmacologic Interventions. Click here to view.
