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Do Research Groups Align on an Intervention’s Value? Concordance of Cost-Effectiveness Findings Between the Institute for Clinical and Economic Review and Other Health System Stakeholders

  • Matthew SussmanEmail author
  • Jeffrey C. Yu
  • Joseph Menzin
Review Article

Abstract

The Institute for Clinical and Economic Review (ICER) employs fixed cost-effectiveness (CE) thresholds that guide their appraisal of an intervention’s long-term economic value. Given ICER’s rising influence in the healthcare field, we undertook an assessment of the concordance of ICER’s CE findings to the published CE findings from other research groups (i.e., “non-ICER” researchers including life science manufacturers, academics, and government institutions). Disease areas and pharmaceutical interventions for comparison were determined based on ICER evaluations conducted from 1 January 2015 to 31 December 2017. A targeted literature search was conducted for non-ICER CE publications using PubMed. Studies had to be conducted from the US setting, include the same disease characteristics (e.g., disease severity; treatment history), incorporate the same pharmaceutical interventions and comparison groups, and present incremental costs per quality-adjusted life-year (QALY) gained from the healthcare sector or payer perspective. Discordance was measured as the proportion of unique interventions that would have had more favorable valuations (i.e., low, intermediate, high value-for-money) if the CE findings from other research groups had been used for decision making instead of ICER’s findings. More favorable valuations were defined as transitioning from low value (as determined by ICER) to intermediate or high value (as determined by other researchers) and from intermediate value (as determined by ICER) to high value (as determined by other researchers). Among the 13 non-ICER studies meeting inclusion criteria, six disease areas and 14 interventions were assessed. Of the 14 interventions, a more favorable valuation would have been recommended for ten therapies if the CE ratios from other research groups had been used for decision making instead of ICER’s findings, representing a 71.4% (10/14) discordance rate. Moreover, these discrepancies were found in each of the evaluated disease areas, with the largest number of discordant valuations found in rheumatoid arthritis (five out of six interventions were discordant) followed by one valuation each in multiple sclerosis (one out of three), non-small cell lung cancer (one out of two), multiple myeloma (one out of one), high cholesterol (one out of one), and congestive heart failure (one out of one). Our findings indicate high discordance when comparing ICER’s appraisals to the CE findings of non-ICER researchers. To understand the value of new interventions, the totality of evidence on the CE of an intervention—including results from ICER and non-ICER modeling efforts—should be considered when making coverage and reimbursement decisions.

Notes

Author Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Matthew Sussman, Jeffrey C. Yu, and Joseph Menzin. The first draft of the manuscript was written by Matthew Sussman and Jeffrey C. Yu and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Compliance with Ethical Standards

Funding

This study received no external funding.

Conflict of interest

Matthew Sussman, Jeffrey C. Yu, and Joseph Menzin declare no conflicts of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Boston Health Economics, LLCBostonUSA

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