The Innovation and Value Initiative (IVI) where I serve as the Director of Research was recently in the news with a Journal of Clinical Pathways interview with Executive Director Jennifer Bright and Director of Scientific Communications Mark Linthicum. Some excerpts:
Can you tell us about the Innovation and Value Initiative?
Bright: We are working in three primary areas. The first is methods development – how do we apply better methods and create better models for assessing value of health care therapies? The second is transparency; we are putting all of our models and research in an open-source environment, much like open-source software development, which is a very novel and forward-thinking approach to what has traditionally been done behind the walls of an academic or research institute. The third core element is incorporating the experience of patients. In the health policy world and in the health care marketplace, there is a lot of discussion regarding patient-centered health care. We believe that this philosophy needs to also be applied to the assessment of therapies’ value. We have to start with understanding the patient experience in disease and their approximation of value – in their choice of treatment options and how they define the value of various outcomes of a treatment.
Let’s talk about CVS Caremark’s new program to use ICER’s version of value assessment. What are the concerns with this program and what do you see as the potential impact that the program may have on patients?
Linthicum: I think one of the main concerns that is raised by the CVS decision is that it uses an estimate of value as a black-and-white justification for coverage decisions, which in our view is an inappropriate way to use estimates of value. There are a couple of reasons for our belief on this. The estimates produced by ICER are one approach, but they are broad population-level estimates that reflect averages across the entire population of clinical trials and do not reflect the heterogeneity and differences in response that are associated with different types of patients, demographics, and genetic markers. One of the most vocal critiques from the patient community has been that ICER also does not adequately incorporate the patient perspective. ICER has made some efforts to correct this by meeting with patient groups and conducting patient surveys prior to releasing reports, but this information is generally included as a brief section providing contextual information, with no discernible impact on actual value estimates.