How ICER’s assessment of a new class of migraine treatments fails patients

A case study on how ICER's recent assessment of migraine treatments fails patients.

Amey Sutkowski
Lauren NevesJuly 10, 2018

How ICER’s assessment of a new class of migraine treatments fails patients.


Over 50 million Americans suffer from migraine and the majority of patients affected by this often debilitating disease are between 25 and 55 years old – the time they are most productive in their careers and family life. Despite these facts, a recent assessment by the Institute for Clinical and Economic Review (ICER) of a new class of migraine treatments – calcitonin gene-related peptide (CGRP) inhibitors – fails to incorporate improvements to patients’ productivity in its price recommendations. ICER’s subjective decision to ignore best practices and exclude productivity benefits shows how its approach skews results to put payer needs over patients.

The burden of disease associated with migraine is significant. Migraine cost employers nearly $13 billion annually due in part to 113 million lost work days. CGRP inhibitors offer new hope to individuals suffering from migraine as the first medicines developed specifically for the prevention of the condition. According to a recent study, CGRP inhibitors could improve patient outcomes and save the economy nearly $400 billion over the next 10 years, including through productivity gains associated with fewer migraine days. The significant impact of productivity on migraine patients makes it an important outcome to consider in any measurement of value of migraine treatments.

In its analysis of CGRP inhibitors, ICER admits that when looking at the value of these treatments from the societal perspective, and when including outcomes such as productivity, the value of the treatments leads to more favorable results. In spite of this, ICER’s final price recommendations exclude the impact of productivity gains and other patient-centered outcomes. This decision not only highlights the subjectivity of ICER’s analysis, it goes against best practices recommended by experts in the field of cost-effectiveness analysis. If ICER’s recommendations were used by payers, it could harm patient access to CGRP inhibitors and prevent them from accessing an important medical advance in the treatment of a costly and debilitating condition. 


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