ICER Doubles Down on Flawed Metrics

How much is a life worth? It’s not an easy question, but that doesn’t stop the Institute for Clinical and Economic Review from trying to calculate an answer – even if it means using biased tools.  

The national health economics organization has long taken flak for using the Quality Adjusted Life Year, or QALY, in its value assessments of new drugs and devices. The flawed metric is biased toward the disabled, aged and people with chronic conditions, undervaluing the lives of these patients.  

Comparing the QALY and evLYG 

In an attempt to be more equitable, ICER now pairs the QALY with the evLYG as part of its number crunching. The economist-developed Equal Value Life Years Gained metric is formulated so that its value will always be higher than a QALY score because it values lived years equally: one year is one year – even for someone who is already seriously ill or aged. 

Yet similar to the QALY, the evLYG model is biased toward the number of days of life as opposed to the quality of life in those days. For example, a life-changing medication to treat chronic migraine – one that allows patients to reliably work, care for their family and contribute to their community – would be valued less than a medication or cure that could extend a life. Treating chronic migraine, in ICER’s view, doesn’t have much value because it doesn’t help patients live longer. 

Discriminatory Coverage Policies Based on Flawed Metrics 

While ICER has touted improvements to its cost assessment approach, organizations including the Alliance for Aging Research have warned of the discriminatory nature of both drug pricing metrics. Using either metric – or both – patient advocates warn, could lead to undervalued treatments. 

Discriminatory coverage practices are also a concern as public and private insurers alike have referenced ICER’s reports when setting coverage policies. The Affordable Care Act prohibits the use of the QALY in Medicare, but policymakers have signaled their intent to use evLYG in drug pricing negotiations.  

Despite adding evLYG to its assessment approach, ICER still leaves out what matters to patients: their quality of life.