The Alliance for Aging Research recently completed a review of the Institute for Clinical and Economic Review’s (ICER) considerations of older adults in their reports over the last two years. In July of this year, ICER received a grant from The Commonwealth Fund to “evaluate procedural changes that could further support health equity goals in health technology assessment.” Their full self-assessment is due to be released in March 2023. To date, ICER’s efforts to incorporate outcomes and societal factors related to equity are commonly considered in their analyses as “contextual considerations,” meaning that they do not positively or negatively impact ICER’s price recommendations.
“From an older adult patient, family caregiver, and societal perspective, there is significant value in medical interventions that prolong independence, alleviate symptoms, and enhance mobility,” said Michael Ward, Vice President of Public Policy and Government Relations at the Alliance. “These are equity-related values that ICER is failing to accurately capture in its base modeling. We hope ICER’s upcoming internal review of its overall equity considerations, as well as its much-anticipated review on Alzheimer’s disease therapeutics, recognizes the importance of filling this critical gap.”
The Alliance explores these impacts and provides recommendations for ways that ICER can improve their methodology to be more inclusive to older adults in this review.
The Alliance encourages ICER to evaluate the following:
- ICER should incorporate the experience of older adults and individuals with a disability in their consideration of health equity;
- ICER should regularly conduct follow-up analyses that incorporate real-world data, including on population subgroups of interest;
- ICER should provide guidance on data quality standards needed for inclusion in assessments, and exercise flexibility when needed to incorporate equity considerations;
- ICER should re-evaluate their reliance on QALY and QALY-derivative analyses, and evaluate the adoption of value frameworks that permit differential valuations among patient subgroups; and
- Consider the creation of an ombudsman to provide an ongoing feedback loop and recommendations to better incorporate equity in assessments.
Read the full analysis.