Cancer and the Long-Term Costs of ICER’s Short-Term Thinking

The heartbreaking headline said it all: a new CAR-T personalized cancer treatment was found “effective, but too costly” by the economists at the Institute for Clinical and Economic Review.

Long story short:

• The CAR-T therapy just became the first of its kind to win FDA approval to treat patients with multiple myeloma. 

• In clinical trials, “three quarters of patients responded to treatment … about a third of whom went into remission.”
• ICER itself declared with “high certainty” that the drug would “provide at least a small net health benefit compared to usual care, with the possibility of a substantial benefit.”
• But ICER found it not cost effective, in part because multiple myeloma afflicts only 35,000 Americans. 

Once again, ICER has found a groundbreaking therapy not worth its cost – this time for an incurable cancer. And once again, ICER’s decision could make it difficult for patients to access potentially life-saving medicine.

ICER: Missing the Trees for the Forest

ICER is not a government agency, but its recommendations influence the health insurers, government entities and pharmacy benefit managers who decide which medicines health plans will cover. Its analysis is inside-out: economists, instead of doctors, weighing what’s best for a system instead of individual patients, based on short-term finances instead of long-term health.

ICER will continue to let down cancer patients as long at its analyses fixate on the health care system and ignore the individual patients who depend upon it. 

Restricting Access Restricts Patients

Personalized medications for life-threatening diseases will, by their nature, be expensive. That makes them hard enough for patients to afford and access. But if insurance companies use ICER’s reports to justify not covering the drugs, access will be restricted to all but the wealthiest patients.

As ICER’s economists should know, incentives matter. Over time, if ICER and the health care system continue to disparage next-generation medicine, eventually there won’t be a next generation of medicines. 

The Long View

Personalized therapies like the CAR-T myeloma treatment signal the future of health care. The question is who will have access to treatment in that future. 

ICER, insurers and lawmakers must recognize that dismissing innovative medicine under the banner of cost effectiveness renders the health care system ineffective at its most basic task: making patients well.