[News article] Whose Numbers Determine if a Targeted Cancer Therapy is “Worth It?”

From the 2 February 2015 Newswise article

Health economics helps insurers, health care systems and providers make treatment decisions based on the cost of extra “units” of health arising from a specific treatment. By calculating the cost for each year of life or quality-adjusted year of life gained, these groups can decide whether changing treatments or adding in a new treatment beyond the existing standard of care is “worth it.”

However, while the resulting incremental cost effectiveness ratio (ICER) is often presented as an absolute measure upon which to base these decisions, an opinion published by University of Colorado Cancer Center researchers D. Ross Camidge, MD, PhD, and Adam Atherly, PhD, suggests that the consumers of these data need to be much more aware of the assumptions underlying these calculations.

“Increasingly physicians are being presented with health economic analyses in mainstream medical journals as a means of potentially influencing their prescribing. However, it is only when you understand the multiple assumptions behind these calculations that you can see that they are by no means absolute truths,” Camidge says.

…..

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• The Therapeutic Paradox: What’s Right for the Population May Not Be Right for the Patient By SCOTT ABEREGG, MD
  “An article in this week’s New York Times called Will This Treatment Help Me?  There’s a Statistic for that highlights the disconnect between the risks (and risk reductions) that epidemiologists, researchers, guideline writers, the pharmaceutical industry, and policy wonks think are significant and the risks (and risk reductions) patients intuitively think are significant enough to warrant treatment….

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Study quantitatively evaluates factors underlying Medicare decisions on medical technology

From the 6 February posting at the CEA Registry blog

Our new study, recently published online in Medical Care (“Factors Predicting Medicare National Coverage: An Empirical Analysis” (1)), highlights factors underlying Medicare decisions on medical technology.

Interventions considered to be particularly controversial or expected to significantly impact the Medicare program in the United States are considered in National Coverage Determinations (NCDs).  Medicare coverage for interventions is limited to eligible items and services deemed “reasonable and necessary” for the diagnosis or treatment of an illness or injury.  What constitutes reasonable and necessary has not, however, been clearly defined.

This study is the first of its kind to quantitatively evaluate the factors associated with positive NCDs…

…Key findings include:
•    CMS favors proven interventions. Compared to interventions with clinical evidence deemed “insufficient”, interventions with good or fair quality supporting evidence were approximately six times more likely to receive a positive decision (p<0.01).
•    Interventions with available alternatives are less likely to be covered. Compared with interventions with no available alternative, those for which an alternative was available were approximately eight times less likely to receive a positive decision (p<0.01).
•    CMS accounts for value in coverage decisions. Compared with technologies estimated to be dominant, i.e., more effective and less costly than the competing intervention considered, those with no published estimate of cost-effectiveness were approximately five times less likely to receive a positive coverage decision (p<0.05).
•    Coverage decisions have become more restrictive over time. Compared with coverage decisions made in the years 1999 to 2001, decisions made from 2002 to 2003 were more than three times less likely to be positive (p<0.05).  Decisions made from 2004 to 2005 were also more than three times less likely to be positive (p<0.1), and from 2006 to 2007 decisions were almost ten times less likely to be positive (p<0.01).

This analysis can help the medical community better understand the type of evidence that Medicare considers in NCDs.  CMS and other payers may also benefit from this kind of external review of coverage decisions as it can help ensure the consistency of decisions and the integrity and accountability of the coverage process.

 

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Can vaccine recommendations be based solely on individual and public health?

http://commons.wikimedia.org/wiki/File:The_cow_pock.jpg

by WILLIAM SCHAFFNER, MD at KevinMD.com (Nov. 15, 2011)

In this cartoon, the British satirist James Gillray caricatured a scene at the Smallpox and Inoculation Hospital at St. Pancras, showing Edward Jenner administering cowpox vaccine to frightened young women, and cows emerging from different parts of people’s bodies. The cartoon was inspired by the controversy over inoculating against the dreaded disease, smallpox. The inoculation agent, cowpox vaccine, was rumored to have the ability to sprout cow-like appendages. A serene Edward Jenner stands amid the crowd. A boy next to Jenner holds a container labeled “VACCINE POCK hot from ye COW”; papers in the boy’s pocket are labeled “Benefits of the Vaccine”. The tub on the desk next to Jenner is labeled “OPENING MIXTURE”. A bottle next to the tub is labeled “VOMIT”. The painting on the wall depictsworshippers of the Golden Calf.

Have you heard the parable about the blind men and the elephant? Each is holding a different part of the animal and comes to a different conclusion about what he’s dealing with. The man holding the tail is sure it’s a rope; the one with the trunk fears a snake; the one holding the tusk is certain he has a spear. It’s all in their perspective. They’ll need to share what they each know and consider the others’ perspectives if they have any hope of understanding the true scope of what they’re facing.

And so it is when a group sits down to talk about the cost-effectiveness of vaccines. If you’re a parent who lost your child to meningitis, the cost of a vaccine dose is trivial. However, if you’re considering this from the population-based, public health decision-making perspective, the annual price tag of $387 million to administer meningococcal booster doses to all 16-year-olds is anything but trivial. If you sit on the Advisory Committee on Immunization Practices, considering, discussing and deciding how much weight to give each of these perspectives and many others is now all in a day’s work.

Read the entire article

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