An Effective Treatment for Alzheimer’s, But Only if ICER Allows It
Three days before Christmas, the Institute for Clinical & Economic Review (ICER) is scheduled to publish a draft assessment of two promising treatments for Alzheimer’s disease. Unfortunately for the millions of Americans living with this fatal illness, it is likely that ICER will be giving lumps of coal, not gifts, this holiday season.
ICER performs studies that declare how much we as patients value medicines that treat devastating diseases like Alzheimer’s. And depending upon their proclamations, patients’ access to life-altering medicines can be meaningfully obstructed.
The organization has a long history of undervaluing medicines and recommending prices that don’t support innovation. Since 2017, ICER has declared three out of every four drugs overpriced based on data from the ICER Analytics platform.
A Joint Economic Committee of Congress report documented that the annual economic costs for Alzheimer’s is nearly $600 billion once the value of the unpaid care for the people living with the disease are considered.
Citing these and other factors, a recent study co-authored by ICER President Steve Pearson acknowledged that when both healthcare and non-healthcare factors (such as caregiver quality-of-life, non-healthcare costs and productivity loss) were considered, the cost-effectiveness of disease-modifying treatments for Alzheimer’s disease were substantially improved.
But ICER rarely accurately acknowledges burdens such as the unpaid care provided by caregivers or patients’ reduced ability to earn a living when valuing medicines. Without a full consideration of all the costs, ICER’s recommended prices will undervalue the benefits from potential therapies.
The organization also has a history of valuing treatments geared toward older individuals as less cost effective. This is another significant undervaluation bias for Alzheimer’s treatments because nearly three out of four Alzheimer’s patients are 75 years of age or older.
ICER’s massive price cuts may sound great, but the chilling effect of stifling medical innovation imposes the highest costs of all. Making matters worse, when combined with the recently passed Inflation Reduction Act, the organization’s appraisals are now more likely than ever to turn into price controls on innovative drugs.
Price controls, wherever they have been tried, do not achieve their intended outcomes. In this case, far too many patients will be denied beneficial treatments to the detriment of their health outcomes.
Ironically, ICER’s recommendations often raise overall healthcare spending as fewer drug treatments lead to more expensive hospital stays and surgeries. The problem of higher total expenditures is particularly concerning for Alzheimer’s given the disease’s severe end-of-life costs.
Discouraging innovative Alzheimer’s treatments is especially troubling because a new generation of monoclonal antibodies, such as lecanemab, are showing promise. These medicines target amyloid plaques in the brain and are demonstrating an ability to slow disease progression in clinical trials.
These treatments are an incredible step forward, but they are not a cure. More innovations are needed. Innovation is a long, risky, and expensive process that builds on itself over time – which is what we have seen with cancer medicines. This will not happen if innovators expect that they will be unable to cover the massive costs of capital necessary to advance research.
Patients do not need to speculate on the adverse consequences that result when price controls undervalue the benefits from novel therapies. Many other countries have been implementing the ICER playbook for years with adverse outcomes for patients’ healthcare quality. For example, after Germany implemented a version of the value assessments ICER conducts in 2011, only 63% of new medicines launched over the next seven years were accessible to German patients, compared with 88% in the U.S.
If we follow Germany’s lead, our health plans are headed in the same direction. A recent Xcenda survey indicates that nearly 60% of U.S. health plans who use ICER reports end up restricting rather than expanding access to treatment.
The evidence is clear: we must not let ICER’s biased and incomplete reports discriminate against Alzheimer’s patients. Market forces are a tried and tested method of encouraging new breakthroughs, such as the forthcoming new Alzheimer’s treatments, while also expanding access to more people. Consequently, policies should focus on improving the market process by improving price transparency and reforming the health insurance markets.
As we head into the Christmas season, patients and their families suffering with Alzheimer’s are wishing for a miracle, not a flawed methodology. Hope may be on the horizon, but not if we let discriminatory and ill-advised analyses get in the way.
Wayne Winegarden, Ph.D., is a senior Fellow in Business & Economics at the Pacific Research Institute, as well as the Director of PRI’s Center for Medical Economics and Innovation.
