WASHINGTON — Drug makers are renewing a long-simmering crusade against a nonprofit that conducts comparative-effectiveness research, trumpeting new data that shows seniors with complex diseases would have a harder time accessing their current medicines if Medicare used its findings to favor some drugs over others.
The analysis, conducted by researchers at AmerisourceBergen’s Xcenda with funding from the industry trade group PhRMA, looked at so-called cost-effectiveness thresholds — a kind of evaluation that insurance companies might use to decide whether a given medicine is worth its price. The study focuses in particular on research from the Institute for Clinical and Economic Review, a Boston-based nonprofit known for tackling questions about the value and efficacy of drugs.
The analysis showed that if Medicare gave preferential treatment to therapies that meet ICER’s cost-effective threshold for patients with rheumatoid arthritis, multiple sclerosis, non-small cell lung cancer, or multiple myeloma, some 59 percent to 93 percent of patients might be forced to switch the therapy they use, depending on the drug they take currently and their respective condition.
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Cost-effectiveness analysis is a valuable, well-established tool for understanding the value of treatments, but the Xcenda study illustrates the imperfection of the traditional application of cost-effectiveness models and why new value measurement approaches are emerging.
Tools like our Open-Source Value Project are built to iterate and adapt with the latest science, incorporate the perspectives of all healthcare stakeholders, and facilitate an open and honest dialogue about value assessment. Most importantly, Innovation and Value Initiative tools are flexible to the needs of the end user, whether that’s a patient or a payer, helping mitigate concerns with cost-effectiveness analysis, which usually focus on the needs of a payer or a broad population.
No patient is average, and accounting for heterogeneity of people and treatments in assessing value is important. IVI looks forward to working to balance the conversation around value assessment by creating tools that advance the science and practice of measuring healthcare value in the way that builds consensus across the diversity of perspectives and viewpoints – with the patient at the center of everything we do.
The Pharma assumption that change is per se bad does not address the question of cost-effectiveness at all.