— ICER reiterates its commitment to equality and will highlight measures of cost-effectiveness that value any extension of life exactly the same across all diseases, regardless of age, severity of illness, or level of disability —
BOSTON, December 12, 2018 – The Institute for Clinical and Economic Review (ICER) has posted a summary of the reasons that the quality-adjusted life year (QALY) is the gold standard for measuring how well a medical treatment improves patients’ lives, and has served as a cornerstone of cost-effectiveness analysis in the U.S. and around the world for more than 30 years.
Along with the academic community, drug manufacturers, and governmental agencies in the US and other countries, ICER uses the QALY as a core measure of how well different treatment options improve the quality and/or length of life for patients. The added cost per QALY gained for new treatments remains the best way for policymakers to understand how well the price of a treatment lines up with its relative benefits and risks for patients compared to other treatment options.
Treatments for patients with serious illness have the greatest opportunity to demonstrate more QALYs gained, thereby justifying a high price. But with growing use of ICER reports to inform drug price negotiations and insurer coverage, concerns have been raised that the use of the QALY could undervalue treatments that extend length of life without improving quality of life. To address this concern of discrimination directly, and ensure that all stakeholders can engage with cost-effectiveness in confidence that it provides analyses that value a year of life for all patients exactly the same, ICER’s future reports will prominently feature a calculation of the Equal Value of Life Years Gained (evLYG). The evLYG is not as flexible as the QALY in capturing benefits to quality of life but does measure any gains in length of life exactly the same across all conditions, regardless of age, severity of illness, or level of disability.
Steven D. Pearson, MD, MSc, President of ICER, issued the following statement:
“The current drug pricing and insurance system is broken and hurts patients every day; that unfortunate reality is plain for all to see. We all want to have better access to the drugs and other care that we and our family members need. The QALY is not the enemy; in fact, it can help. An objective look at how well drugs improve both quality and length of life leads to a more honest discussion about whether the prices set by drugmakers are fair or not. It sets a clear target for price negotiation; when negotiation leads to fair prices, innovative treatments that make a real difference in patients’ lives get their due reward, patients and insurers save money when it could be put to better use elsewhere, and patients reap the ultimate benefits of broader access to more affordable health care.
“By highlighting the evLYG measure of health gain, we are responding to deeply held feelings expressed by some critics that the QALY could discriminate against vulnerable patient groups. We hope that raising the profile of the evLYG will reassure them and policymakers that when treatments offer the opportunity to extend lives, between the QALY and the evLYG we will make sure that each day, month, or year of extra life will be valued equally.
“But attacking any form of cost-effectiveness analysis as a source of information does not serve the interests of patients, be they young, healthy, old, sick, or disabled; it leaves everyone at the mercy of the current system in which manufacturers charge as much as they can and insurers react by restricting care and placing more financial burdens on patients. That should not be our fallback position for today. That cannot be the future we leave our children. They deserve a system that guarantees everyone a fair price and ready access to the care that patients and their doctors determine is best for them. We look forward to continuing to listen to feedback on our methods of evidence analysis, and will continue to respond by reaching out to make sure that all patients have their voice heard in our reviews and public meetings. We also look forward to continuing our efforts to provide independent analyses to drive change and make sure that both manufacturers and insurers align their efforts to reward the care that most improves patients’ lives.”
Additional details about the QALY and evLYG can be found here. ICER welcomes broad stakeholder feedback on both metrics when we formally update our value assessment framework in 2019.
The Institute for Clinical and Economic Review (ICER) is an independent non-profit research institute that produces reports analyzing the evidence on the effectiveness and value of drugs and other medical services. ICER’s reports include evidence-based calculations of prices for new drugs that accurately reflect the degree of improvement expected in long-term patient outcomes, while also highlighting price levels that might contribute to unaffordable short-term cost growth for the overall health care system.
ICER’s reports incorporate extensive input from all stakeholders and are the subject of public hearings through three core programs: the California Technology Assessment Forum (CTAF), the Midwest Comparative Effectiveness Public Advisory Council (Midwest CEPAC), and the New England Comparative Effectiveness Public Advisory Council (New England CEPAC). These independent panels review ICER’s reports at public meetings to deliberate on the evidence and develop recommendations for how patients, clinicians, insurers, and policymakers can improve the quality and value of health care. For more information about ICER, please visit ICER’s website.