Finding the Patient Voice in ICER’s Value Assessments

October 12, 2018
Earlier this week, Xcenda released research co-authored with the Partnership to Improve Patient Care (PIPC) that examined the extent to which the Institute for Clinical and Economic Review (ICER) incorporates stakeholder input in its final assessments. Value assessment frameworks such as ICER have been criticized by patient advocacy groups for not taking into account patient perspectives when evaluating therapies. This research aimed to quantify the extent to which ICER meaningfully engages patient advocacy groups and other stakeholders through its public comment process. Xcenda developed a new methodology that systematically analyzed the degree to which stakeholder comments were acknowledged and incorporated into final ICER assessments. 

Findings from the analysis indicated that ICER has formally acknowledged over 95% of comments received from stakeholders in writing since refining its process in 2017 for public comments. Despite this, ICER only incorporated 27% of all stakeholders’ comments into its final assessments. Feedback was more likely to be incorporated into final assessments when a recommended solution was provided by stakeholders and for comments specific to methodological issues, as compared to general feedback. 

Input from patient advocacy groups, in particular, was half as likely to be incorporated into ICER’s final assessments compared to other stakeholders. Patient advocacy groups tended to provide comments that were less solution-oriented and less targeted relative to industry stakeholders and were most likely to comment on the adequacy of existing evidence, incorporation of the patient perspective, and ICER’s transparency.

Patient advocacy groups have expressed concern that the increased uptake of ICER’s framework by PBMs, such as CVS Health, state Medicaid formularies, and the Department of Veterans Affairs, poses barriers and risks limiting beneficiaries’ access to important treatments. 

Xcenda’s research in collaboration with PIPC reinforced the importance of developing patient-centered value assessment frameworks and identified areas of high concern for patient advocacy groups relating to ICER’s evaluations. Further, this research highlighted the need to make evaluations and related documents, such as economic models and analysis plans, more accessible and understandable to patients and patient advocates. The results illustrated the need to refine and improve 2-way communication between patient advocacy groups and ICER throughout all stages of ICER’s evaluation process. 
Read the report to learn more.

Health Policy Weekly is written by Xcenda, a consultancy and business unit of AmerisourceBergen Specialty Group. Visit Xcenda’s online archive to access more health policy news.

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