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For the past few years, the Institute for Clinical and Economic Review has filled an important void in the U.S. by assessing the extent to which new medicines — notably, high-priced treatments — may be cost effective. But a plan to charge drug makers for advice prior to product launches prompted skepticism from a Wall Street analyst who believes such a move would, if nothing else, help the pharmaceutical industry.

“This is a change from past practice where it relied on donations and conference organizing,” wrote Bernstein analyst Ronny Gal in an investor note. “We do not question ICER staff’s integrity, but it is very hard to not grow to like your clients. This funding mechanism is, respectfully, inherently problematic for an organization whose mission is to become the fair arbiter of drug value.”


Indeed, over the past few years, ICER has become something of a go-to watchdog for cost effectiveness, a status that has at times roiled different drug makers that have complained about methodology and transparency. Two years ago, for instance, Amgen (AMGN) very publicly questioned the extent to which an ICER review would fairly evaluate new multiple myeloma medicines.

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  • ISPOR Pub – today:How Health State Utilities Used in Cost-Effectiveness Models Are Currently Identified, Reviewed, and Reported
    In this article Brazier et al., who led a recent ISPOR Task Force on the use of health state utilities (HSU) in cost-effectiveness models, demonstrate that modelers from both commercial and non-commercial settings currently select HSUs in an ad hoc manner, haphazardly adjusting them without justification, and that these poor standards are accepted as the norm by peer reviewers.

  • Ed,
    Concerning ICER’s methods, aspects such as outcomes projections over the episode of illness and utility assessments (easily challenged) can render ICER value estimations questionable. Biases in these judgments can be material.

  • Ed Silverman — concerning bias (funding and many, many other forms) one should focus on the WHAT of the work, rather than the WHO. Ken Rothman wrote a article in JAMA 269(21):2782-2784 “Conflict of Interest: The New McCarthyism in Science”. It is worth a read and still current. Joe

    • Hi Joe,
      Thanks for writing in.
      I understand the point. I’ve been covering pharma for 23 years and the issue arises repeatedly. Bias can occur, so better to know about financial relationships.
      That said, we need to know more about what ICER will propose – and then might do. Yes, the work is, fundamentally, the key thing, but nothing exists in a vacuum, either.
      All best,
      ed at pharmalot

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