Uncertainty Plagues ICER Report on Type 2 Diabetes

Just one thing stands between some Type 2 diabetes patients and disease management: a dislike of needles.  A new pill form of semaglutide, a medicine that aids in digestion and blood sugar regulation, could make treatment more feasible for these patients – improving lives and lowering overall health care costs.

But the Institute for Clinical and Economic Review has other ideas.

The controversial Boston-based health economics organization released a new evidence report that deems oral semaglutide not cost effective.  Perhaps that’s because ICER omits or undervalues several key factors in its calculation.  

The value of adherence. An oral form of semaglutide could help bring patients in line with their doctors’ orders.  But ICER’s report doesn’t fully account for that benefit.     

The true cost of diabetes.  ICER uses diabetes cost figures from 2012.  But the past seven years have surely added to the disease’s financial toll on the health system.  

Differences in patient responses.  Oral semaglutide offers an additional treatment option for Type 2 diabetes patients who cannot control their disease with existing medications.  The report doesn’t fully account for what better management could mean for these patients.

Comorbidities. Type 2 diabetes patients often face additional conditions such as cardiovascular disease.  Oral semaglutide is associated with a lowered rate of adverse cardiovascular outcomes for such patients, which could mean longer lives and lower health care costs over time. ICER’s report comes too soon to fully factor in these benefits.

By underestimating both the impact of the disease and the value of better controlling it, ICER offers an assessment tainted by uncertainty. In fact, even ICER’s economists “urge caution when interpreting these findings as they are highly uncertain.”  They also admit that the assessment’s “overarching limitation” is the complexity of Type 2 diabetes, the number of co-morbidities that diabetes patients face and diabetes’ “patient-specific” clinical management.  

In other words, ICER’s one-size-fits-all approach isn’t doing justice to the real-world complexities of diabetes.  

ICER’s report is too riddled with data gaps to reflect what more treatment options and better adherence could mean for people living with Type 2 diabetes.  Nevertheless, the report may influence coverage trends among health plans and Medicaid programs, where ICER has a proven influence.

For people living with diabetes, every day requires precise attention to diet, blood sugar and medication regimen.  They know attention to detail is paramount. If only ICER did as well.


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