ICER framework threatens to halt continued progress against multiple myeloma

The ICER value framework threatens to halt continued progress against multiple myeloma.

Holly Campbell
Holly CampbellMay 26, 2016

ICER framework threatens to halt continued progress against multiple myeloma.

Progress in the fight against multiple myeloma, a cancer of the blood and bone marrow, has been nothing short of remarkable.

Just a decade ago, patients diagnosed faced a poor prognosis and treatment options were largely limited to chemotherapy, often associated with severe side effects.

Now, thanks in large part to biopharmaceutical discovery and innovation, multiple myeloma is a very treatable disease for many patients and survival rates for the approximately 27,000 Americans diagnosed each year have improved dramatically. Today, more than 80 percent of newly diagnosed patients are living more than four years. In 2015 alone, four new medicines were approved to treat this rare form of blood cancer, including two first-in-class therapies, offering patients entirely new ways to treat their disease.


Biopharmaceutical researchers hope that the 41 medicines in development for multiple myeloma could help increase the survival rate. We look forward to hearing more at next week’s annual meeting of the American Society for Clinical Oncology about continued advances in treating multiple myeloma.

In contrast, an advisory panel made up largely of payers will assess multiple myeloma treatments using a flawed value framework developed by the Institute for Clinical and Economic Review (ICER) that threatens to put the brakes on continued progress against multiple myeloma.

When well-structured and used appropriately, frameworks to assess the value of medical tests, treatments and health care services can be useful in the private market to support patient-centered health care. That is why we are proud to support work by organizations such as the International Society for Pharmacoeconomics and Outcomes Research and the National Health Council to advance better approaches to value assessment.

However, the model developed by ICER uses methodology that is systematically biased against continued progress, devaluing advances through blunt budget caps and one-size-fits-all value thresholds that ignore the complex realities of optimally caring for cancer patients in an era of personalized medicine.

As highlighted by the make-up of ICER’s St. Louis advisory panel, the ICER model chooses payer needs over patients’ needs. Like the advisory panel, ICER’s Governing Board also is dominated by payer representatives. 

While public stakeholders were given only two weeks to provide input on ICER’s 172-page report, that hasn’t stopped them from weighing in. Here is what patient and provider groups are saying about ICER’s assessment of multiple myeloma treatments:

ICER’s framework does not account for the aspects of value that matter to patients.

  • “… the current ICER’s model represents only some components of the overall care and may overshadow other dimensions of care that are also valuable to patients … The patient perspective is not incorporated into ICER’s value framework … absent is the guidance of real world experience and preferences of the patients.” – Cancer Support Community

ICER’s framework does not accurately reflect how physicians treat patients and could be used to dictate physician prescribing and patient access.

  • “Unfortunately, the scope of ICER’s analysis is far too narrow because it does not represent the realities of clinical practice. As such, [the American Society for Hematology] believes that the type of analysis has only limited value in determining the just price and utility of novel drugs and drug combinations in this rapidly advancing field … ASH is concerned that ICER’s analysis will be used to limit the options for patients in receiving the best possible treatment for a very difficult and complicated disease.” – American Society for Hematology

ICER’s framework, which relies on a QALY-based cost-effectiveness analysis, conflicts with the movement toward personalized medicine.

  • The QALY is a rigid measure with many known limitations, especially the inability to assess the value of medicines for rare diseases, like refractory myeloma, where there are many DNA alterations in myeloma cells frequently differ from patient-to-patient.” – Cutaneous Lymphoma Foundation
  • “ICER’s framework is not consistent with the current thinking in regard to the future of cancer treatment. The trend is towards more personal, customized approaches and not subjecting every patient to the same treatment regimen.” – Multiple Myeloma Research Foundation

Learn more about how ICER’s model doesn’t meet patients’ needs and support continued improvement in health care here.

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