Unbiased Analysis of Today's Healthcare Issues
Standard cost-effectiveness measures the value of a treatment based on the cost for an additional unit of health where units of health are measured in quality-adjusted life years (QALYs). For Alzheimer’s disease, however, this approach may be limited. A paper by Garrison et al. (2021) identifies the petals of the value flower that are particularly…
What is a rare disease? The definition varies across countries, but according to the European Medicines Agency (EMA) rare diseases are those with a prevalence of <5 cases per 10,000 people; ultra-rare diseases are those with <1 case per 50,000 people. In most cases, rare disease must not only be rare but also severe, often…
Cost effectiveness analysis aims to capture identify (and monetize) all of a treatments benefits, risk and costs and then determine if the treatment is worth the money. Traditionally, however, benefits, risk and costs only related to benefits that accrue to the health care system. Many studies in the academic literature have advocated for a societal…
Should the US have a formal, centralized health technology assessment (HTA) organization? In the United Kingdom, the National Institute for Health and Care Excellence (NICE) plays this roles and has a significant impact on drug pricing in the UK. However, the UK relies on a single payer system and NICE’s recommendations can be directly implemented…
When evaluating a new diagnostic, HTA agencies must assess two separate issues: analytical and clinical validity. Analytical validity basically indicates whether the test works; is it able to accurately predicts the presence or absence of a particular biomarker of interest. Clinical validity is whether the test matters in clinical practice. It could be the case…
Created by the Affordable Care Act (ACA) in 2010, the Patient-Centered Outcomes Research Institute (PCORI) has funded a wide variety of research comparing different treatments to one another. One thing PCORI was forbidden from funding, however, was cost-effectiveness analyses. Section 1181 of the Social Security Act, however, has expanded the scope of the types of…
Clinical trials are typically of (relatively) short duration, but innovative treatments may impact patient survival over multiple years. Health economists and outcomes researchers often are faced with the challenge of extrapolating clinical trial survival curves to estimate long-term survival gains for the typical patient. These estimates may be done parameterically (e.g., exponential, Weibull, Gompertz, log-logistic,…
The Academy of Managed Care Pharmacy (AMCP) held an interesting webinar titled “5 Years of ICER – Insights and Impact on Payers“. Some highlights form the presentation. Most relevant information Jeremy Lee from MedImpact–a pharmacy benefits manager (PBM)–noted that their Pharmacy and Therapeutics (P&T) committee used four key pieces of evidence when making coverage and…
At drug launch, treatments have some benefit and cost. However, drug prices may change over time. Additionally, treatment benefits may rise or fall depending on how well efficacy translates into effectiveness and how well physicians learn to manage adverse events. Mattingly and Love (2020) provide a case study of how cost-effectiveness analysis can change over…
According to a paper by Stevens et al. (2020), the answer is ‘yes’. One clear reason why it would change is if the drug’s price changes. Even if that is not the case, however, the drug may be more or less effective over time. For instance, physicians may improve their ability to manage side effects…