ICER’s Asthma Report Comes up Short

It’s plagued by incomplete analysis and missing data, yet the Institute for Clinical and Economic Review’s draft evidence report on severe asthma medicine still manages to deliver a familiar refrain.  All five of the drugs reviewed, ICER reports, are not cost-effective.

The determination – like the report itself – is premature.  

As with previous reports from the controversial health economics organization, this one went public before researchers analyzed all pertinent data.  “We hope to have more…data prior to the final report,” ICER notes at one point in the draft, assuring readers that “We will update…for the final report.”

There’s just one problem.  Stakeholders, including the patients and advocates directly impacted by access to these therapies, are responding to this version of the report.  Should additional data substantively change ICER’s findings, stakeholders have wasted their time.  And, perhaps, missed the opportunity to provide meaningful input on ICER’s full findings.

Meanwhile, the gaps in ICER’s analysis suggest a woefully incomplete grasp of uncontrolled asthma.  For instance:

  • ICER acknowledges that children with severe asthma experience lifelong complications.  But it does not factor the cost of these complications into its valuation of severe asthma therapies.
  • ICER does not incorporate the potential for reduced comorbidities in its valuation of severe asthma therapies.  
  • ICER does not incorporate the value of quality-of-life factors that impact patients with severe asthma, such as the ability to sleep or exercise, or the ability to attend school.

ICER’s report also disregards an unfortunate reality: socio-economic and racial disparities.  African Americans are three times more likely to die from asthma. Hispanics and Puerto Ricans are also at higher risks for environmental hazards that lead to allergic or asthmatic responses. By creating more barriers to treatment, the report could actually compound existing disparities for these patients.

The Institute for Patient Access outlined perennial shortcomings of ICER analyses in its April 2018 paper, “The ICER Myth.”  The paper details how ICER issues reports before full information is available, overlooks quality-of-life factors, and takes a one-sized-fits all approach to patient treatment.  The end result: restrictive policies that block patients from accessing life-changing medicine.

This latest draft report brings these concerns to light once again, proving that – when it comes to severe asthma therapies  – ICER’s conducting business as usual.


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