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The Institute for Clinical and Economic Review’s newest cost-effectiveness report underscores just how far economic modeling sometimes diverges from patients’ reality, explained the Institute for Patient Access in a February 17 letter.  The report analyzes rheumatoid arthritis treatments’ value by modeling expenses for simulated patients over a lifetime on certain treatments.

Targeted immune modulators such as biologic treatments exceed ICER’s cost-effectiveness threshold, the report concludes.  But the model used to reach this conclusion may not reflect patients’ reality, raising questions about the report’s validity and its impact on patient access.

[SEE: Why ICER’s Model Doesn’t Work for Rheumatoid Arthritis Patients]

ICER Reports

The Institute for Clinical and Economic Review uses its value framework to assess innovative medication’s long-term cost effectiveness and short-term budget impact. In its final reports, the organization establishes a medication’s “benchmark,” price, which can influence health plan coverage for advanced medicines that may exceed that price.

Past reports have analyzed treatments for asthma, diabetes, psoriasis and various forms of cancer.

ICER’s Model vs. Patients’ Reality

Using economic data to potentially limit physicians’ decision making and patients’ treatment options remains controversial.  So do certain statistical quality measures, such as quality-adjusted life years.  But the Institute for Patient Access argued in its letter to ICER that such an approach falls particularly short with regard to rheumatoid arthritis.

“Health plans may use [ICER’s] conclusion to limit patients’ options for RA treatment,” the Institute for Patient Access noted in its letter, “despite the fact that ICER’s model for calculating cost effectiveness is, arguably, ill-suited for arthritis treatments.”  IfPA laid out four reasons that the model falls short:

  1. ICER’s homogeneous cohort does not reflect the reality of treating rheumatoid arthritis’ heterogeneous patient population.
  2. ICER’s lifetime horizon for calculating cost effectiveness overestimates the duration of patients’ treatment with any given therapy.
  3. ICER’s budget impact numbers do not accurately reflect rising health care costs in the United States.
  4. ICER’s measures of quality do not fully encompass RA patients’ experiences.

IfPA urged ICER to take these factors into consideration before releasing the final draft of its report on April 7.

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