Perceptions of ICER Reports and Health Technology Assessments in the United States

Michael Barry, MD, PhD, clinical director at the National Centre for Pharmaceoeconomics in Dublin, Ireland, initiated the session, “Payers’ use of Independent Reports in Decision Making—Will There Be an ICER Effect,” with a presentation on how Institute for Clinical and Economic Review (ICER) reports will be relevant to organizational assessments. 

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Dr Barry began with a brief overview of the rising health care costs around the world, stating that affordability of medications and health care treatment is a critical issue in the industry. For ways to help make drugs more affordable, he listed three key strategies: apply rigorous health technology assessments (HTAs) to the patented side of the market, reduce expenditure in the off-patent side of the market, and look deeper into the use of biosimilars. 

In focusing on expanding HTA, Dr Barry said that this could be an area where ICER reports would be very valuable to payer organizations because they evaluate all available medical evidence and make it easier for organizations to identify the products that improve patient outcomes and control costs. However, he also concluded his presentation by stating that ICER reports will be less valuable when it comes to reimbursement decisions.

In another presentation, Allen Lising, PhD, managing director at Dymaxium (Toronto, Canada), discussed how US payers are utilizing ICER’s assessments and if they will have any impact on negotiations with pharmaceutical companies. 

Dr Lising began by describing the results of an online survey distributed to US health care decision makers and individuals part of the centralized, evidence-based product evaluation ecosystem. Questions were related to how these individuals use ICER’s assessments and what they believe to be their limitations. 

Results showed that 59% of individuals or organizations used one or more ICER reports last year. However, only 9% of respondents said that they used them when preparing to meet with manufactures, and only 13% said they used the reports for price or listing negotiations at those meetings. 

Instead, the reports seemed to be more frequently used as an evidence source in preparing recommendations and to inform or validate analyses. More than half of respondents (64%) reported using the reports during their drug research process and said that the comparative clinical effectiveness (75%) sections of the reports were the most beneficial to them.

The timing of the reports was overwhelmingly the greatest limitation listed by respondents (49%). This is likely due to the fact that most payers initiate research for drugs prior to their approval, and ICER reports are available only after a drug has been approved by the US Food and Drug administration (FDA), a time when there can be much confusion about whether it truly offers more benefit for patients. 

Closing his portion of the session, Dr Lising stated that most respondents (60%) said that access to locked or unlocked versions of models in the reports was an area that would increase the usefulness of the reports. This figure was followed closely by making the report available prior to FDA product approvals (56%). 

Federico Augustovski, MD, MSc, PhD, director of the HTA and economic evaluation department at the Institute for Clinical Effectiveness and Health Policy (Buenos Aires, Argentina) was the final presenter in the session, where he discussed good practices in HTA for decision-making from a Latin-American perspective. 

In order to solve the main challenge of balancing needed improvements with available resources, Dr Augustovski stressed the importance of finding adequate methods of assessment, adapting them to the context of the organization, and gradually strengthening the link between HTA and decision-making.  

According Dr Augustovski, international evidence is widely used in Latin America. Indeed, results of a recent study found that, in 76% of cases when a decision was made in a Latin American country, the HTA report used was not from that country. This highlights the importance of looking to ones neighbors to identify approaches that best fit the organization and inform coverage policy.  

In this regard, he concluded that the cost-effectiveness data and overview of available evidence found in ICER reports make them a welcomed addition to providing more transferable analyses and methods for HTA.