ICER Watch: ICER faces new criticism for excluding patient input

ICER Watch: 12 fixes to ICER’s broken value framework

ICER is facing a wave of new criticism over excluding patient input on its flawed value framework.

The Institute for Patient Access has identified a dozen problems with the Institute for Clinical and Economic Review’s value framework. In a recent letter to ICER, the organization warns that ICER’s value framework could affect patients’ ability to access life=saving treatments.

“Far from an end unto itself,” the letter explains, “a calculation such as ICER’s value-based price benchmark goes on to inform crucial health plan features such as formulary design, cost-sharing ratios and the use of utilization management tools such as prior authorization and step therapy.”

And the group drove home just how important it is for patients. The Institute for Patient Access warns, “These factors often determine whether a patient can access the treatment prescribed by his or her physician, and whether a physician can direct patient care as needed.”

The Institute for Patient Access says ICER should start by:

  • Formally and transparently involve patients and clinician stakeholders throughout the valuation process.
  • Incorporate patient reported outcomes in the comparative assessment of clinical effectiveness.
  • Patients should participate in identifying which outcomes are to be used to evaluate the effectiveness of a new treatment compared with existing treatment options.

Check out the organization’s letter to ICER and all 12 recommendations in its detailed report.

National Health Council to ICER: Engage Patients

The National Health Council, which represents more than 100 national health-related organizations and businesses, is urging ICER to incorporate patients into its decision-making.

In a letter to ICER, the organization expressed concerns about ICER’s exclusion of the patient’s perspective from its value frameworks.

“We strongly recommend ICER adopt an open and collaborative process for identifying and appointing additional patient representation in your governance as well as create additional opportunities for patient engagement,” Marc Boutin, the organization’s CEO, writes in a recent letter to ICER. “We are concerned that emphasizing the budget impact of treatments using assumptions and arbitrary thresholds for short-term budget impact may be used as a rationale to restrict patient access, particularly when they are established without the context of any offsetting long-term benefits that are important not only to payers, but to patients and their families.”

Among its four recommendations, the National Health Council urges ICER to “explicitly describe how patient input and preferences were considered and incorporated in its assessments to help ensure accountability to patients, demonstrate responsiveness to patient input, and help patients better understand the information ICER finds useful.”

Quote of the Day: Value calculations should not be conducted at the bedside

“Value calculations should not be conducted at the bedside.”

— Scott Huntington, MD, MPH, MSc, assistant professor of medicine in the section of hematology at Yale University

Our quote of the day comes from Yale University’s Dr. Scott Huntington, who recently engaged in a point-counterpoint debate at

In Case You Missed It: Patients Rising Talks ICER, Patient Engagement with Journal of Clinical Pathways

This month, our co-founder and policy director Jonathan Wilcox sat down with the Journal of Clinical Pathways to talk ICER, value frameworks and the need for patient engagement. In the September issue, Jonathan explains how the Institute for Clinical and Economic Review, known simply as ICER, is undermining patients’ access to life-saving treatments with its value frameworks.

On value frameworks: “Value frameworks as a general theory are something that we have concerns about. They place what we see as a disproportionate focus on cost, which is a challenge, but not our only challenge. That gives patients an inaccurate picture of the totality of their health care challenges as well as the system’s challenges.”

On ICER’s value framework: “My fundamental and unmovable, unshakeable dispute with ICER’s Value Assessment Frameworks is that they seek to cap treatments and slash investments in medicines as a way of addressing health care economics, and that is just going to threaten patients. That’s really all there is to it.”

On clinical pathways: “I am against anything that, in any way, blocks the clinical judgments of the doctor-patient relationship. To me, that is unacceptable. Clinical pathways and value frameworks will be destructive to the doctor-patient relationship and the judgment of those individuals. I think that clinical judgments influenced by cost management are something very troubling. We need to stop having our health care decisions made by those who know the cost of everything, but the value of nothing.”

On a patient’s responsibility: “As an organization, we believe that patients also have a responsibility in all of these endeavors… I think patients have to make sure they are as knowledgeable as they can be, which will be helpful to both them and their doctor.”

Check out the entire interview in the September issue of the Journal of Clinical Pathways.

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