More Questions on ICER’s Arbitrary Value
More questions are being raised about ICER’s value framework. Nicole Gray of BioPharmaDive writes about the growing criticism for “arbitrary benchmarking.”
In Gray’s piece, our friend Robert Goldberg, co-founder of the Center for Medicine in the Public Interest, identifies flaws in ICER’s value framework, which undermines patients’ access to life-saving treatments.
“Health is an investment,” Goldberg explained to BioPharma Dive. “Like other investments, the up-front costs are often high, but the returns accrue over a lifetime. Drugs that are hugely effective and that treat broad swaths of the population would by any other metric be considered socially valuable.”
We share his concern. ICER’s arbitrary framework undervalues innovation. It ignores the reality that new treatments have decreasing costs over time.
“Certain frameworks require that future spending on medical innovations be capped at the historical share that medical innovations have comprised in overall health care spending, which is wholly inconsistent with rewarding value,” says Goldberg. “If technologies become more effective over time, their share of overall health care spending should increase.”
Pay For Cures Like We Pay For Homes
Forbes’ Yevgeniy Feyman has a novel idea for funding innovation in treatments: Pay for cures like we pay for homes.
“Essentially, when you pay for a home you amortize the value of the home (plus some interest rate based on your credit-worthiness) over some period of time. That’s the only way that a $200,000 house can be affordable for a family earning, say, $50,000. We use the same approach for student loans – which makes a $40,000/year education realistic (there are, of course, issues with the underlying cost of college education and how loan amounts are determined).”
This piece challenges the way we think about health care. Life-saving treatments are akin to investing in an education, which pays off by extending and improving our quality of life. Today, we treat our health differently. We ignore the future value created by a treatment.
“A better approach would recognize that the benefits of curative treatments don’t accrue immediately,” Feyman writes. “A person cured of HCV may avoid a liver transplant 30 years down the line. The cured patients can also be more productive, avoiding the awful effects of interferon therapy. This means that for curative treatments, amortizing the cost over time may present a better approach.”
Get Sicker Before Getting Help
The Boston Globe editorial board is calling out fail first policies, which require patients to get sicker before they can get the right treatment.
“How do you justify withholding a wonder drug from patients infected with a liver-killing virus until the disease starts to ravage their bodies?” the editorial asks. “Why, in other words, do they have to become seriously ill before receiving help?”
The editorial singles out the treatment of patients with Hepatitis C, who are struggling to gain access to life-saving treatments.
“Massachusetts, which has long been a leader in health care innovation and reform, needs to do better when it comes to hepatitis C. The disease carries a stigma because it frequently is spread by the use of needles to inject drugs such as heroin, but neither that nor the cost of treatment should override compassionate policymaking. State health officials and agencies, working with insurers, should develop a plan to make treatment available to anyone who has the virus, with the approval of a doctor. It would save lives and money over the long term.”
5 Questions on Sean Parker’s Cancer Initiative
Sean Parker, the tech mogul who helped launch Napster and Facebook, recently announced plans to invest $250 million in cancer research. Stat News’ Sharon Begley has five questions about Parker’s cancer investment. Among the questions:
- Will the money make much difference?
- But aren’t these new initiatives trying a new approach?
- Is too much money chasing too little talent — or too few ideas?
- Do we need new financial models for bringing drugs to market?
- Can a billionaire with a vision jump-start research?
These are great questions and should always accompany the big headlines. To put Parker’s contribution into perspective, Begley reports that the National Cancer Institute spends $5.2 billion per year on research.
“It is hardly obvious that infusing money into these labs in order to speed up their level of interaction and collaboration will markedly accelerate the pace of discovery, innovation, and the development of new forms of cancer immunotherapy,” says cancer biologist Robert Weinberg of the Whitehead Institute at the Massachusetts Institute of Technology.
None of this is to minimize or dismiss the value of Parker’s investment in research. Our goal is to help provide patients with more context beyond that headline in your Facebook feed.