In a win for patients, ICER pulls report aimed at reducing access to medicines

My Patient Rights | Stay Informed | In a win for patients, ICER pulls report aimed at reducing access to medicines

In a win for patients, ICER pulls report aimed at reducing access to medicines

On September 27, the Institute for Clinical and Economic Review (ICER) declared that it was re-evaluating its Evidence Report on three new treatments for rheumatoid arthritis (RA) after it found that these new medicines would not be cost-effective to consumers. While ICER had only just released their draft on September 26, the action to reassess these claims is an important victory for patients who rely biopharmaceutical innovation that allows for effective new treatments to come to market.

While the draft report on AbbVie’s Rinvoq, Pfizer’s Xeljanz and Eli Lilly and Incyte’s Olumiant suggested that the first two treatments have “marginal” clinical benefits and the third was unable to be analyzed due to a lack of data, ICER chose to walk back its claim while reworking its draft report to reflect an updated model that will supposedly offer a stronger cost-effectiveness analysis on these medicines. Since their last cost-effective analysis in 2017 on RA drugs, ICER has adjusted their review to better reflect real-world usage of these drugs, and considered the likelihood of patient remissions as a factor of consideration.

A common evaluation method used in the ICER report – quality-adjusted-life-year (QALY) – can be a source of contention when not applied correctly or without complimentary alternative measures. QALY was developed by health economists that were focused on determining the cost of care, but lacked the patient-centered approach that is important when determining cost-effectiveness of a medicine or care. Worse, QALY can be discriminatory against people with disabilities and chronic conditions, since patients with certain conditions are “worth” less of an investment from a care standpoint. As a patient, you should not be measured by a number that can put you at a disadvantage when receiving care.

The use of QALY is increasingly under focus as alternative tools that are more personalized offer a better sense of control in health care spending. As ICER and other agencies understand that the human element in determining cost-effectiveness is crucial in providing equal care to all consumers, all patients will be better off.

ICER’s new draft is slated to be released in the next few days, which will prompt a period of comments on the report, followed with a revised draft and a public meeting before the report is finalized on November 19. We will be sure to keep you updated on any new findings or developments that occur!


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