On Jan. 31, the Institute for Clinical and Economic Review (ICER) released its final revisions to its value assessment framework. The document describes changes in ICER’s process, including creating a formal process for incorporating new evidence that emerges after the assessment, standardizing cost-effectiveness thresholds across reviews, and increasing the incorporation of real-world evidence.
While the revised framework seeks to formalize a patient engagement program, the program falls short in committing to meaningful incorporation of patient perspectives and preferences into ICER’s reviews. ICER commits to work with patient groups throughout the process, but it does little to ensure that the patient voice is heard. The framework also makes it clear that economic analysis still maintains primacy at ICER and would be counted as more valuable than patient input.
In response to a request for feedback, stakeholders submitted comments on ICER’s draft 2020 value assessment framework last summer, but ICER failed to incorporate their suggestions in several important ways. First and foremost, ICER doubles down on its embrace of the discriminatory QALY measure and its cousin, the equal value of life years gained (evLYG) measure. Stakeholders also called on ICER to meaningfully incorporate patient preferences, but ICER instead opted to ceremonially consider patient input and not commit to patient-centered decision making.
In response to a request for feedback, stakeholders submitted comments on ICER’s draft 2020 value assessment framework last summer, but ICER failed to incorporate their suggestions in several important ways. First and foremost, ICER doubles down on its embrace of the discriminatory QALY measure and its cousin, the equal value of life years gained (evLYG) measure. Stakeholders also called on ICER to meaningfully incorporate patient preferences, but ICER instead opted to ceremonially consider patient input and not commit to patient-centered decision making.
ICER's Revised Framework Fails to Capture Stakeholder Feedback
The group did adopt a process to use real-world evidence (RWE) to update assessments of treatments that were approved under an accelerated pathway after the treatment has been on the market for two years. ICER does not, however, commit to using RWE in its base models, choosing to continue to conduct rushed assessments before appropriate data are available.
Unfortunately, ICER’s updated framework does not take a meaningful turn towards patient-centeredness. Under these revised guidelines, ICER will continue to use discriminatory measures to argue for reduced access to life-changing treatments.
Unfortunately, ICER’s updated framework does not take a meaningful turn towards patient-centeredness. Under these revised guidelines, ICER will continue to use discriminatory measures to argue for reduced access to life-changing treatments.
| pipc_icer_framework_.pdf |
