ICER Fumbles Rheumatoid Arthritis Report

The controversial Institute for Clinical and Economic Review has done something unprecedented: admitted it’s wrong.

Earlier this month, the Boston-based health economics organization publicly announced the shortcomings of its recent cost-effectiveness report on rheumatoid arthritis.  But it didn’t stop there. It actually withdrew the report and agreed to try again. Why? In ICER’s own words, the organization needs to “reevaluate some of the assumptions and calculations within the draft.”

The concerns are justified.  ICER originally intended to compare three JAK inhibitors, biologic drugs that treat rheumatoid arthritis, for efficacy and cost.  Then the organization’s economists determined that the comparison was undoable. The clinical trials for the three drugs had “somewhat different patient populations, primary endpoints, timing of assessments, and timing of allowable switching to alternative therapies,” ICER explained in its now-retracted report.  

In other words, the necessary data just wasn’t there.  And that’s not entirely unusual for the organization, which regularly attempts to assess the efficacy of drugs that haven’t yet been approved by the Food and Drug Administration – and to determine the cost-effectiveness of drugs that don’t yet have a price.  

In this instance, ICER nevertheless announced that two of the rheumatoid arthritis drugs have only “marginal” benefits – a bold claim given that more patients reached remission or reduced disease activity with the JAK inhibitors than with traditional treatment.

Biologics prevent rheumatoid arthritis from progressing to permanent joint damage in most patients.  Even ICER acknowledged as much in the initial scoping document for its analysis.  That means improved quality of life for patients, productivity at work and reduced impact on caregivers.  

But for ICER, these qualitative benefits are overshadowed.  Its economists focus on costs to the health care system, “direct medical and pharmacy costs,” rather than value to the individual patient.  It’s a perennial shortcoming of the number-crunching organization.  

ICER’s updated rheumatoid arthritis evidence report, scheduled for release October 11, may adjust for its economic mishaps, and that’s important.  But perhaps the bigger fix is a more fundamental one – finding a meaningful way to incorporate patients’ values, not just budget considerations for the health care system.