Evaluating cost effectiveness is one thing; using value assessments to rank patients’ treatment options is quite another. Yet that’s precisely what the Institute for Clinical and Economic Review attempted in its recent draft report, “Targeted Immunomodulators for the Treatment of Moderate-to-Severe Plaque Psoriasis: Effectiveness and Value.”
ICER’s Value Reports
The psoriasis publication is one in a series of such reports that evaluates advanced medical treatments using ICER’s value framework. ICER analysts calculate a medication’s long-term cost effectiveness as well as its short-term budget impact on the U.S. health care system. It then derives a medication’s ideal, or “benchmark,” price. Far from being an arbitrary measurement, ICER’s benchmark prices can influence health plan coverage for advanced medicines.
Recent reports have analyzed the cost effectiveness of treatments for asthma, diabetes and various forms of cancer.
Institute for Patient Access’ Response
In an October 20 letter to ICER, the Institute for Patient Access explained why ranking therapies was inappropriate – and inconsistent with ICER’s own data. “In this analysis of targeted therapy for psoriasis,” IfPA’s letter noted, “cost-effectiveness ratios do not provide a basis for discriminating among treatments.” The letter further explained that “…the cost-effectiveness ratios of all agents fall under (or very close, in the case of etanercept) the threshold used by ICER. Therefore, it is unclear why ICER concludes that only infliximab represents ‘good economic value.’”
IfPA also noted that patient feedback was not sufficiently incorporated into the draft report. “ICER consulted patient advocacy groups, and they voiced challenges with current therapies – specifically poor tolerability and inconvenience – particularly with applying topical agents and with multiple injections. These are important aspects that should have been incorporated in the model, as they do affect patients’ quality of life,” IfPA’s letter explained.
IfPA acknowledged that, “In the interest of patients’ ability to access these treatments, IfPA is pleased that ICER’s analyses show all targeted agents to be cost-effective and to carry a budget impact below ICER’s limit.” It urged ICER, however, to incorporate the feedback provided as the organization finalizes the draft. To learn more, read the Institute for Patient Access’ response letter.
Analyses from organizations such as ICER can justify health plans in limiting access to advanced medicine or reducing treatment options. Restrictive plan designs can, in turn, curb physicians’ ability to choose the best treatment for their patients.
ICER is scheduled to issue its final report on plaque psoriasis treatments on November 4.