ICER's Updated Value Framework Open for Public Comment

The Institute for Clinical and Economic Research (ICER) has opened up its updated value framework for a 60-day public comment period. Feedback received by ICER during this time will be evaluated and incorporated as seen fit, before the final changes are made to the framework. ICER plans to use the final framework to guide its evidence assessment reports for the period between April 2017 and April 2019.

ICER is one of several organizations involved in the process of creating a value framework that can ultimately guide clinicians, payers, as well as patients make informed decisions on treatments and coverage. The motivation for developing this guidance, according to ICER’s president Steven Pearson, MD, MSc, FRCP, is the lack of discussions that connect drug efficacy with value—this led to ICER’s creation of a value-based price benchmark.

The following are a few of the updates proposed for the existing framework, which can be used across healthcare services, including drugs and devices, procedures, and delivery system interventions.

• Conceptual structure of the value framework. The term “care value” will be replaced with “long-term value for money” for summary judgement of value. The new framework will eliminate “long-term value” and short-term affordability.” Instead, the new framework will consider these elements to seek “sustainable access to high-value care” for patients.
• Comparative clinical effectiveness. Intent to evaluate evidence beyond just randomized control trials (RCT), to judge the comparative clinical effectiveness of care options. ICER wants to include evidence from non-RCT sources, including data from “grey literature.”
• Incremental cost effectiveness analysis. Quality-adjusted life year (QALY) will remain the primary measure for this evaluation. A broader threshold has been recommended: between $50,000 to $150,000 per QALY. While the health system perspective will be the base case, work productivity will be included when feasible. A scenario analysis will be developed when a high change in pricing can be anticipated in 12 to 24 months.
• Budget impact analysis. A potential budget impact analysis will not be included conceptually in the report. Rather than estimating the real-world uptake of a new intervention, ICER will present information that will allow stakeholders to consider the potential budget impact of a new service based on assumptions of price and uptake.
• Stakeholder engagement. ICER has created improved templates to stimulate greater patient participation in scoping and providing more information.

The complete report can be accessed here.

ICER’s claims that they are trying to create a non-biased framework. The updated proposal states that ICER does not intend to target any specific interest group, unlike the original framework that was aimed at health plans and payers.

The president of the National Pharmaceutical Council, Dan Leonard, said in a statement, “We recognize that developing frameworks is challenging and appreciate that ICER has made significant changes. We look forward to reviewing the updated framework in greater detail and understanding how these changes could work in practice.”