The Institute for Clinical and Economic Review’s (ICER) recently made a call for suggestions and feedback on how to improve its value assessment framework and methods. We are a strong supporter of value-driven health care, including the use of rigorous value frameworks and evidence to support health care decision-making. Here are five improvements we recommend ICER make to its value framework to ensure that it is patient-centered, methodologically rigorous, and aligns with 21st century health care.
Seek alternative approaches to value assessment, such as multi-criteria decision analysis (MCDA), rather than quality adjusted life years (QALYs):
- “While the QALY, which provides a single number summarizing the ‘value’ of a treatment, is a commonly used metric for quantifying health benefits, patients do not receive treatments in isolation … It is extraordinarily difficult to translate QALY-based assessments into real-world decision-making in clinically appropriate, patient-centered ways.”
- “Applying MCDA would allow individual users of ICER’s reports to assign weight to different elements of value, and arrive at their own estimate of a treatment’s worth … It has the potential to make value assessment customizable, transparent and comprehensive, while incorporating other elements of value that patients care about.”
Expand assessments and results to reflect what matters to patients and society:
- “ICER should follow the recommendations of thought leaders in the field by expanding their value elements to incorporate other elements of value that matter to both patients and society.”
- “By drawing attention to the average effectiveness of a treatment for an entire patient population, ICER ignores, and encourages payers to ignore, important differences in the clinical needs and preferences of patients.”
Remove the short-term budget threshold from the value assessment framework:
- “ICER’s reliance on short-term affordability thresholds runs counter to efforts to achieve truly value-based care ... and we continue to believe that ICER should cease estimating short term affordability to avoid serious, unintended consequences for future patients and innovation.”
Take a holistic approach to value that reflects all health care services:
- “If ICER was truly dedicated to improving health care and guiding evidence-based resource allocation, assessments would take a holistic view of the health care system, not focus on a sector that accounts for just 7 percent of total health spending.”
- “ICER’s assessments primarily focus on new medicines, in contraction to their stated intention of not targeting a single group, while making no attempt to assess and recommend prices for health care services well known to be of low value.”
Integrate clinicians and patients into the value assessment process:
- “ICER is not fully integrating patients and other critical stakeholders into the value assessment process. ICER must ensure that individuals participating in the value assessment process, particularly clinical experts, have disease-specific experience and expertise.”
Read the full comments here.
To learn more about value assessments, visit www.phrma.org/value-collaborative.