Study Urges Caution Before Adopting ICER Reviews to Determine Cost Effectiveness of Treatments

Share on Facebook
Share on Twitter
Share on
LinkedIn
+

Review methodology could negatively impact elderly, the disabled, cancer patients and those with rare diseases

Media inquiries: Contact Micaela Dawson, 617-723-2277 ext. 203 or mdawson@pioneerinstitute.org

BOSTON – As states continue to grapple with prescription drug costs, a new Pioneer Institute study lays out the key ethical, methodological and disease-specific questions policy makers should address before deciding whether to contract with the Institute for Clinical and Economic Review (ICER) to conduct cost effectiveness reviews used to make decisions about the purchase of medicines and other medical innovations.

ICER utilizes Quality Adjusted Life Years (QALYs), a controversial evaluation technique that assigns an economic value to the longevity and quality of human life.

“The use of the QALY standard in the United Kingdom resulted in British cancer patients having some of the worst access to new cancer treatments in all of Europe and created a political crisis for British politicians,” said William Smith, author of “Key Questions for Legislators on the Institute for Clinical and Economic Review (ICER).” “U.S. politicians may want to proceed cautiously in adopting QALYs.”

QALY is controversial because of the impact that such a methodology may have upon access to medical innovations for older Americans, the disabled, patients with cancer and patients with rare diseases.

The National Health Service (NHS) in the United Kingdom utilizes QALY metrics.  But in the United States, the Affordable Care Act banned the use of QALYs for Medicare programs because of concerns about the impact upon older Americans, the disabled and the terminally ill.

Because of the vulnerability of these patient populations, Pioneer recommends that legislators avoid using ICER reviews until they are fully confident that the reviews will neither have an adverse impact upon these vulnerable populations nor discourage biopharmaceutical innovation for important unmet medical needs.

Download our one-page summary, Key Questions for Legislators.”

About the Author

William S. Smith is Visiting Fellow in Life Sciences at Pioneer Institute.  He has 25 years of experience in government and in corporate roles, including as vice president of public affairs and policy at Pfizer, and as a consultant to major pharmaceutical, biotechnology and medical device companies. He held senior staff positions for the Republican House leadership on Capitol Hill, the White House, and in the Massachusetts Governor’s office. He is affiliated as research fellow and managing director with the Center for the Study of Statesmanship at The Catholic University of America (CUA), where he earned his PhD.

About Pioneer

Pioneer Institute is an independent, non-partisan, privately funded research organization that seeks to improve the quality of life in Massachusetts through civic discourse and intellectually rigorous, data-driven public policy solutions based on free market principles, individual liberty and responsibility, and the ideal of effective, limited and accountable government.

Get Updates On Our Healthcare Research and Events!

Make a tax-deductible gift below to support our work to protect patients.

Related Posts:

Pioneer Institute: 340B Hospitals Does Not Necessarily Translate to Charity Care

Review of Becker’s List of Health Systems with Strong Finances…

New Online Tool Tracks MA Hospital Revenue from Commercial Sources

A new online tool from Pioneer Institute shows a gradual increase in non-commercial (public payer) revenue at Massachusetts hospitals and also reveals a strong relationship between the hospitals with the highest commercial revenue and those with the highest relative prices.

Telehealth Progress Slowed in 2023

A new report by Cicero Institute, Pioneer Institute, and Reason Foundation reveals worrying stagnation in state-level telehealth expansion efforts in 2023, with only a few exceptions. Progress made during the pandemic is being lost even as provider shortages worsen, raising concerns about patients’ access to care.

Opinion: Drug patents aren’t a ‘necessary evil.’ They save lives.

Drug patents are one of the most important public policy innovations in all of human history, and a boon to patients awaiting cures. Inventions only come when inventors are rewarded, not punished. Patents are not a “necessary evil.”

Study: High List Prices and Deep Discounts for Prescription Drugs Hurt Poor and Sick Patients

A new Pioneer Institute study illustrates how the current system of drug pricing and discounts leads to patients with challenging diseases being charged huge out-of-pocket sums to keep other premiums low, effectively imposing financial penalties on the sick to protect the healthy and wealthy.

Study: Massachusetts Should Join 45 States and Allow Prescribers to Dispense Medications

A Pioneer Institute study shows that middlemen—commercial pharmacies and pharmacy benefit managers—add substantial costs over wholesale prices. Allowing prescribers to dispense routine drugs would save consumers money without compromising safety.

As COVID-19 Emergencies Ease, Some Progress on Telehealth Rules

A new report from Reason Foundation, Cicero Institute and Pioneer Institute rates every state’s telehealth policy for patient access and ease of providing virtual care. The report highlights telehealth policy best practices for states.

First-of-Its-Kind Interactive Mapping Tool Reveals Extent of For-Profit Entities Benefitting from the 340B Drug Pricing Program

Today, Pioneer Institute released a first-of-its-kind, 50-state mapping tool and database highlighting the troubling way in which hospitals and covered entities leverage unlimited pharmacy contracts under the 340B Drug Pricing Program.

Survey Finds Spotty Compliance Among Hospitals with Federal Price Transparency Law

A 2019 federal law requires hospitals to make prices for 300 shoppable services available online in a “consumer-friendly format,” but a Pioneer Institute survey of 19 hospitals finds that information on discounted cash prices—the price most likely to be charged to consumers paying out of pocket—was unavailable at seven of those hospitals.

Massachusetts Hospitals Pull Back on Charity Care as Revenue from Federal 340B Drug Discount Program Explodes

Over the past decade, the revenue for hospitals generated by the federal 340B drug discount program, initially intended to serve low-income, uninsured populations, has exploded even while a number of important Massachusetts hospitals have reduced the level of charity care they provide, according to a new study published by Pioneer Institute. The Pioneer Institute study, “340B Drug Discounts: An Increasingly Dysfunctional Program,” notes that nationwide, 340B drug sales rose from $9 billion in 2014 to $38 billion in 2020.

The Promise and Challenges of Rare Cancer Treatments

Dr. William Smith, Pioneer Institute's Visiting Fellow in Life Sciences, spoke about the challenges and opportunities for rare cancer treatments, in a video interview produced by Rare Cancers, a patient group based in Australia, for the November 26th CAN Forum. 

Study: Decline in Cardiovascular Health Screenings During COVID-19 Pandemic Poses New Public Health Threat

Pioneer Institute today released a new analysis focused on cardiovascular disease, An “Impending Tsunami” in Mortality from Traditional Diseases?, that examines how the COVID-19 pandemic has created another unrelated public health crisis. The Pioneer analysis examines how a single-minded public health focus on COVID-19, social distancing, and lockdowns drove reductions in screenings, diagnoses, and early treatment for complex conditions such as heart disease.

Pioneer Institute Statement on the Commonwealth’s Discontinuance of the COVID-19 Weekly Public Health Report

Useful information about COVID cases or deaths at individual homes has become less available at a time when cases are increasing again, even among vaccinated residents. Pioneer urges Massachusetts to immediately reinstate the so-called Weekly Report, which contains cases and deaths inside individual nursing homes.

Study: Massachusetts Should Retain Additional Healthcare System Flexibility Granted During Pandemic

Massachusetts’ emergency declaration for COVID-19 ends on June 15, and with it some enhanced flexibility that has been allowed in the healthcare system.  Some of the added flexibility highlighted barriers that make the system more expensive, harder to access and less patient-centered, and the Commonwealth should consider permanently removing these barriers, according to a new study published by Pioneer Institute.

Study Calls for Better Reporting on Impact of COVID-19 in Eldercare Facilities

Over time, the Massachusetts Executive Office of Health and Human Services and Department of Public Health (DPH) have improved reporting about cases and deaths from COVID-19 in state-regulated eldercare facilities, but flaws and omissions remain and should be corrected, according to a new study published by Pioneer Institute.

New Analysis: ICER Framework Ignores Patient Preferences, Innovation & Societal Benefits in Evaluating Cost-Effectiveness of New Cancer Treatments

Pioneer Institute today released a new analysis, The QALY and Cancer Treatments: An Ill-Advised Match, that examines the alarming methodological and contextual shortcomings of the Quality Adjusted Life Years (QALY)-based methodology in evaluating new cancer therapies. The Pioneer Institute analysis reveals five specific problems with ICER’s evaluation of cancer treatments and demonstrates the urgent need to prohibit the use of the QALY amid trends in rapid cancer innovations and personalized medicine.

Study: Massachusetts Should Embrace Direct Healthcare Options

Especially in the COVID era, many are looking to alleviate the increased burden on the healthcare system.  One solution is direct healthcare (DHC), which can provide more patient-centered care at affordable prices and is an effective model to increase access to care for the uninsured, underinsured and those on public programs like Medicaid, according to a new study published by Pioneer Institute.

Survey: Consumers Want Healthcare Price Information, But Few Realize It’s Available

Great strides have been made to increase healthcare price transparency through online cost estimator tools and a state law that requires providers to give out price information. Yet despite the eagerness of consumers to access prices and out-of-pocket costs, many are unaware that such information is available and don’t know how to access it, according to survey results published by Pioneer Institute.