Value Viewpoint: October 4, 2024

A new article published in ClinicoEconomics and Outcomes Research, “Consideration for Health Disparities in Value Assessment Frameworks,” reviewed 19 ICER reports for the inclusion of health disparity-related patient and caregiver input. Study authors found that there were 30 equity-related themes included across 5 domains:

• Individual
• Interpersonal
• Employer
• Community
• Societal

However, the?study authors also found that the inclusion of these equity-related considerations was not consistent across reports and that they were not necessarily aligned with the patient and caregiver input received as part of the assessment process.

Study authors stated in the discussion:

“The findings from this review indicate an inconsistency in the consideration of health disparities in ICER value assessments. Although ICER engages patients, caregivers, and advocacy groups, integrating these perspectives remains limited. These inconsistencies can perpetuate inequalities in healthcare decision-making, resulting in the continued marginalization of vulnerable populations and the risk that future policy decisions will not fully consider the experiences of all patients.”?

On Tuesday, Value in Health published new research co-authored by NPC , “Will ICER’s ‘shared savings’ approach decrease value-based prices most for the most severe diseases?” The authors reviewed 89 unique conditions covering the 260 FDA-approved therapies between 2019 and 2023 and found that ICER’s shared savings approach would have the largest negative impact on severe, rare, and pediatric diseases:

“ICER’s shared savings assumptions disproportionately and negatively impact its recommended price for treatments targeting rare, severe, and pediatric diseases and may, therefore, reduce incentives to develop new health technologies for these conditions.”

I, along with a wide range of healthcare stakeholders, have been opposed to ICER’s shared savings approach since it was introduced. It lacks scientific rigor and introduces perverse incentives, including perpetuating inefficient care and disincentivizing the development of needed treatments. Here are several resources to learn more about these concerns:

• Cencora Issue Brief: Valuing potential cures: An examination of ICER’s approach to assessing high-impact single and short-term therapies
• My LinkedIn columns: Why is ICER Charging Ahead with Its Flawed “Shared Savings” Approach ? and 8/9/24 Value Viewpoint
• Video: Kimberly Westrich's ICER Recommendations to Improve Drug Pricing Data Accuracy

?The Value in Health October Issue was released last week, with several interesting articles (some of which I have written about previously):

• Integrating Price Benchmarks and Comparative Clinical Effectiveness to Inform the Medicare Drug Price Negotiation Program from Sean Sullivan, Inma Hernandez, and NPC summer scholar Emma Cousin . The co-authors estimate initial price offers for the first 10 drugs selected for the CMS Medicare Drug Price Negotiation Program (also see the September 20 Value Viewpoint for a follow-up article on the next set of drugs anticipated to be included in the DPNP).
• Uncertainty in Long-Term Relative Effectiveness of Medicines in Health Technology Assessment (see the July 12 Value Viewpoint for my previous write-up)
• Does Willingness to Pay Differ for Mental and Physical Health? (see the July 19 Value Viewpoint for my previous write-up)
• Patient-Reported Outcome Measures as an Intervention: A Comprehensive Overview of Systematic Reviews on the Effects of Feedback which seeks to comprehensively assess the impact of PROM feedback on both patient outcomes and care process outcomes, and which finds that PROM feedback may enhance care process outcomes but its impact on patient outcomes is less clear.?

??? Eye on ICER

Here’s the ICER calendar with upcoming reports & meetings:

Reports:

- 10/21/24: Transthyretin Amyloid Cardiomyopathy — Final Evidence Report

- 10/31/24: Epstein-Barr Virus Positive Post-Transplant Lymphoproliferative Disease — Revised Evidence Report

- 12/9/24: Acute Pain — Draft Evidence Report

- 12/12/24: Unsupported Price Increases Occurring in 2023 — Policy White Paper

- 12/19/24: Fair Access: Coverage Policies in 2024 — Policy White Paper

- 2/5/25: Acute Pain — Revised Evidence Report

- 2/6/25: Retinitis Pigmentosa – Draft Evidence Report

- 3/4/25: Special Assessment to Inform CMS Drug Price Negotiation: Breo Ellipta and Trelegy Ellipta – Final Report

- 3/26/25: Retinitis Pigmentosa – Revised Evidence Report

Meetings:

- 11/14/24: Epstein-Barr Virus Positive Post-Transplant Lymphoproliferative Disease — Public Meeting (New England CEPAC)

- 2/28/25: Acute Pain — Public Meeting (Midwest CEPAC)

- 4/11/25: Retinitis Pigmentosa – Public Meeting (New England CEPAC)

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