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ICER versus NICE cost-effectiveness analyses have different capabilities.

ISPOR’s 20th Annual European Congress in Glasgow is fast approaching, with the first plenary session scheduled for this Monday, November 6th. I will be attending as part of BHE’s team and am looking forward to the plenary sessions discussing the evolution of value in healthcare, including the increase in value-based care initiatives, the future of health technology assessments (HTA) in Europe, and future expectations for valuations of health technologies. I am also excited to moderate an issues panel at ISPOR Glasgow that is focused on the methods for conducting cost-effectiveness analyses (CEAs), specifically the ICER versus NICE cost-effectiveness analyses. Here’s a quick preview of what this panel plans to address.

Almost every day, I see unflattering news stories regarding drug pricing and the cost of pharmaceuticals. Whether it’s a supplier raising the costs of essential drugs like the Epi-Pen several-fold or a new CAR-T drug priced at a seemingly exorbitant rate – not unlike a three-bedroom house here in the Boston area – media and government scrutiny is clearly growing. What does this imply about the market of pharmaceuticals? Is it irrevocably broken? Perhaps not.

Over the past several months, our Modeling & Evidence team has been busy tracking the Institute for Clinical and Economic Review’s (ICER) movements. In early February 2017, ICER released a revised Value Assessment Framework, the conceptual framework for guiding their evaluations of clinical and cost-effectiveness. After a three month open-comment period, the final ICER Value Assessment Framework for 2017-2019 was posted in June. Below is a recap of our reviews of the revised and the final frameworks, with a focus on ICER’s methodological approach to estimating an intervention’s value for money.

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Researchers at Boston Health Economics, the Carolina Urologic Research Center, and Janssen, also found high hospitalization rates associated with metastatic prostate cancer. WALTHAM, MA, September 15, 2017 –—A new real-world evidence study shows that the development of prostate cancer metastasis was associated with a five-fold increase in medical costs at the time of diagnosis, and substantially higher costs thereafter. Published in the May issue of Cancer, the scientific journal of the American Cancer Society, the study, titled “Impact of Subsequent Metastases on Costs and Medical Resource Use for Prostate Cancer Patients Initially Diagnosed with Localized Disease,” was conducted by BHE, the Carolina Urologic Research Center (CURC), and Janssen. Cancer also published an editorial by Drs. Daniel Frendl and Aria Olumi that discusses the value of this study’s data in the same issue of the journal. The study, led by Drs. Tracy T. Li, PhD (Janssen), Neal D. Shore, MD, FACS…

Methodologists in the HEOR community have been busy over the past 9 months. In September 2016, the Second Panel on Cost-Effectiveness in Health and Medicine published a special communication in JAMA (and subsequent hardcover book) that sought to provide guidance for improving the quality of cost-effectiveness (CE) analyses. A few months later in February 2017, the Institute for Clinical and Economic Review (ICER) presented updates to its Value Assessment Framework, which contains its conceptual approach for conducting incremental cost-effectiveness analyses (CEAs). While ICER’s framework sets to guide their internal modeling efforts and makes no claims to influence general modeling principles, HEOR practitioners throughout the industry may turn to ICER’s framework for guidance especially as the organization gains national attention.

In early February, the Institute for Clinical and Economic Review (ICER) presented proposed updates to its Value Assessment Framework, based largely on stakeholder feedback received during a public comment period in late 2016. These updates focused on four domains of the framework: (1) comparative clinical effectiveness; (2) incremental cost-effectiveness analysis (CE); (3) other benefits or disadvantages; and (4) contextual considerations. While each domain is important, the incremental cost-effectiveness analysis has proved the most controversial. Since the current comment period is almost up, here’s my review of the updates to the CE framework.

As we make our way through the first quarter of 2017, there are a lot of exciting changes happening in the field of health economics and outcomes research (HEOR) that may have important implications for how researchers generate and disseminate evidence.

Early last month the Institute for Clinical and Economic Review (ICER) released a revised Value Assessment Framework for public comment based on feedback received from patients, clinicians, life science companies, and other stakeholders. While a majority of the proposed changes lacked real luster, there is one proposed change that pharma should take note of: ICER’s new method for estimating the cost-effectiveness (CE) threshold.

At BHE, we spend a lot of time speaking with leaders in the field of real world data about the ways in which they go about generating robust, reliable evidence for use with key stakeholders both internally and externally.  Fundamentally, the unique way that companies combine database experts, processes, and technology provides the best indication of success.  Below are a few of my thoughts on this topic based on conversations with our clients and industry stakeholders in 2016.