Unbiased Analysis of Today's Healthcare Issues
That is the title of my latest Perspectives from the Healthcare Economist article published in The Evidence Base this week. Here is the teaser: In this guest column, healthcare economist Jason Shafrin (FTI Consulting and Mann School of Pharmacy, University of Southern California) explores a widening divide over how health systems define value, and what that means…
Let’s say that there is a very severe disease—let’s call it horriblitis—with significant impacts on patient morbidity and mortality. The only available treatment for horriblitis is drug called BlackPill. BlackPill improves health outcomes by 1 QALY over best supportive care (BSC), but costs $500,000 over the patient’s lifetime. While not cost effective by traditional standards,…
President Trump’s May 12 Executive Order around Most-Favored-Nation drug pricing argues that countries outside the US need to raise their prices on pharmaceuticals saying that many other countries are “freeloading” and paying less than their share for pharmaceuticals. In response, pharmaceutical companies have increased prices in the UK and even threatened to “walk away” from…
Last month, the American Heart Association (AHA) and American College of Cardiology (ACA) put out a statement on how new cardiovascular medical technologies should be evaluated from a cost and value standpoint (Kazi et al. 2025). This is an update from their 2014 cost/value methodology (Anderson et al. 2014). What does the AHA/ACC statement say?…
Should health technology assessment (HTA) processes consider using distributional cost effectiveness analysis (DCEA) to incorporate technology impacts on inequality? Some say ‘yes’ and some say ‘no’. Let’s take a look at both sides. No In a Letter to the Editor in Value in Health, Sreeram Ramagopalan noted that NICE currently has a number of concerns…
That is the subtitle of a paper by Vreman et al. (2020). The authors look at all treatments approved by FDA and EMA that were subsequently reviewed by HTA bodies in both jurisdictions between 1995 and 2018. The authors used ICER as the US HTA body; European HTA bodies included IQWiG (Germany), NICE (UK), ZIN…
“I’d like to see Generalized Cost Effectiveness Analysis become the norm for how we assess value.” – Rep. Jake Auchincloss (D-MA 4th District) See the full interview here. To learn more about GCEA, check out the GCEA User Guide published last year.
When conducting evidence synthesis, many individuals use the PICO framework. PICO stands for population; intervention; comparator(s); and outcome. This helps to describe the research question that the evidence synthesis aims to answer. However, recently Remiro‐Azócar (2024) proposed PICOSI framework. PICOSI stands for: Population Intervention Comparator(s) Outcomes Summary effect measure; Intercurrent events In fact, Canada’s Drug…
The answer is ‘yes’, but the question is in what manner? A paper by Che et al. (2024) examines the use of real-world data (RWD) across 2016-2023 HTA assessments. Over this time period, 11% of HTA submissions included real-world data. Further, they find that: The main sources of RWD considered in the submissions were disease…
Meng Li (2024) has a nice summary of the generalized cost effectiveness analysis (GCEA) user guide paper (see Shafrin et al. 2024) that was published last month. The GCEA methodology encompasses 15 ‘petals’ across four domains. The uncertainty domain captures how risk aversion and uncertainty in treatment outcomes impact value, including aspects such as outcome…