Regarding the Institute for Clinical and Economic Review

The Institute for Clinical and Economic Review (ICER) is an obscure but potentially critically important organization. (don’t let your eyes glaze over yet) The corny 2 minute video at their website (shown above) explains what ICER does and why it does it. Short answer made shorter: ICER evaluates the cost-effectiveness of new drugs, in part by comparing their cost-benefit profile with existing drugs to treat the same diseases.

Guess who hates ICER?
Hint: Pioneer (new) drug companies and the GOP
Answer: Pioneer drug companies and the GOP

Why? Money.

In an article, Special Report: Big Pharma wages stealth war on drug price watchdog, Reuters reports on how things are going with ICER:

“(Reuters) - As evidence grew this spring that the drug remdesivir was helping COVID-19 patients, some Wall Street investors bet on analysts’ estimates that its maker, Gilead Sciences Inc, could charge up to $10,000 for the treatment.

Then a small but increasingly influential drug-pricing research organization, the Institute for Clinical and Economic Review (ICER), said the treatment only justified a price between $2,800 and $5,000. Shortly after, Gilead announced it would charge about $3,100 for a five-day treatment and $5,700 for ten days - in line with the ICER recommendation.

The episode illustrates the growing power of the Boston-based nonprofit to hold down U.S. drug prices. Over the past five years, ICER has pressured drugmakers to lower the cost of nearly 100 drugs. It aims to play a similar role with emerging COVID-19 treatments and vaccines. Health insurers increasingly use ICER's fair-value analyses to limit access to expensive drugs or to negotiate steeper discounts with drugmakers. (For a graphic on drugs ICER has rated overpriced, click tmsnrt.rs/3hiYULv).

The industry has moved aggressively to combat the threat to its profits in two ways: With open criticism of ICER’s formula and with a stealthier campaign to undermine its credibility through proxies, including veterans’ groups and organizations that claim to advocate for patients but have ties to the pharmaceutical industry, Reuters found in a review of industry connections and funding among groups targeting ICER. 

Two such groups – the Partnership to Improve Patient Care (PIPC) and Value our Health – are led by employees of Thorn Run Partners, a Washington-based lobbying and public relations firm that counts nearly a dozen drugmakers as clients. PIPC denied it is part of a larger industry-financed proxy campaign to undermine ICER’s impact. Thorn Run declined to comment, and Value Our Health did not respond to inquiries.

As remdesivir gained momentum, PIPC complained to ICER in a June letter that its methodology, which examines how a drug improves patient quality of life, was unfair for COVID-19 drugs. It also held a webinar for patients criticizing ICER’s methods.

The group’s chairman, former U.S. Democratic Representative Tony Coelho, argued in the letter that ICER’s methods yield a flawed value assessment for COVID-19 drugs that could lead insurers or government programs to limit coverage to the elderly and people with disabilities because ICER’s formula attributes a lower value to their medicines than those for healthier patients. In a statement to Reuters, Coelho attacked ICER’s formula as a flawed “one-size-fits-all assessment.”

Gilead also pushed ICER for a higher price during its remdesivir review. The firm told Reuters that ICER’s assessment failed to consider savings from shorter hospital stays and underestimated how much insurers or the government would be willing to pay.

Remdesivir is the only COVID-19 treatment ICER has assessed so far. Steven Pearson, a Harvard academic who started ICER, said it will likely review more coronavirus treatments if they make it to market, including potentially those being developed by Regeneron and Eli Lilly and Co that use antibodies to generate an immune response. The two companies declined to comment.

ICER’s assessments are not used to deny care to patients based on their health, Pearson said. Rather, the formula helps insurers or government programs choose the most cost-effective treatment for a specific condition, based on its price and benefit in providing a better quality of life. Pearson pointed out that the formula has long been used in the health systems of countries including England, Canada, the Netherlands and Sweden.

PHONY GRASSROOTS CAMPAIGN 

The industry has followed the same playbook before: soliciting criticism from outside groups - some of which it finances or staffs - to create the impression of a broad-based patient uprising against ICER’s pricing assessments rather than an industry push to protect profits. 

Last year, ICER invited input as it revamped its assessment methods. Two of more than 50 comment letters came from six California veterans’ groups, who blasted an ICER contract with the U.S. Department of Veterans Affairs (VA), saying its formula denies veterans care and “inherently discriminates” against people with disabilities.”

If it sounds like doing what ICER does is a no-brainer good thing, that is because it is a no-brainer good thing. What is a brain exploder is the fact that this kind of analysis is not being done by the federal government to inform the public about when they are being price gouged. Once again, lobbyists backed by special interest campaign contributions and a corrupt two-party political system serves special interests at the expense of the public interest.

The industry response: Lies & insulting irrationality

The Remdesivir company complained that ICER’s assessment (1) failed to consider savings from shorter hospital stays, and (2) underestimated how much insurers or the government would be willing to pay. Both complaints are either irrational or a lie. First, ICER is fully aware of benefits from shorter hospital stays and any other source from drug treatments. Their analyses ignore no known benefits, otherwise it would not be a “cost-benefit” analysis. That assertion is a lie.

Second, it is irrational to argue that what insurers are willing to pay is completely irrelevant to a cost-benefit analysis. Whatever insurers are willing to pay will be paid by consumers one way or another, e.g., higher insurance premiums or no access to drugs at all (‘extreme health care rationing’). Cost is cost. This argument is insulting in its irrationality and intent to deceive the public.

Also insulting and irrational is the industry tactic of its sleazy, deceptive phony grassroots campaigns.

Lies, insults and irrationality are all legal and just business as usual, i.e., money talks and the public interest walks.

ICER'S TEN LEAST COST-EFFECTIVE DRUGS
ICER’s recommended price based on a cost effectiveness threshold of 

$100,000 per quality year of life gained from the drug