ISPOR: The International Society for Pharmacoeconomics and Outcomes Research

How valuable are digital data collection tools in healthcare and what do they mean to the patient? Are they helpful or is this revolution merely a hype? These were some of the discussions during the plenary session on the second day of the International Society for Pharmacoeconomics and Outcomes Research 23rd Annual International Meeting.

Posters presented at the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 23rd Annual International Meeting in Baltimore, Maryland, highlighted healthcare costs for patients with treatment-resistant depression, off-label drug use in children with depressive disorder, and incidence of depression in patients diagnosed with late-stage cancer.

Legislation, advancing science, and more sophisticated patient advocacy has led to a proliferation of new therapies to treat rare diseases, and society has begun to indicate a willingness to pay for these more expensive therapies, said Clifford Goodman, PhD, senior vice president and director, Center for Comparative Effectiveness Research, The Lewin Group.

There is a monumental amount of data being collected in healthcare, but now it’s time to make sure that data is empowered so it can start being used to answer questions and improve decision making, said Sally Okun, RN, MMHS, vice president, Policy and Ethics, PatientsLikeMe.

At the first plenary session at the ISPOR 2018 conference, May 19-23 in Baltimore, Maryland, panelists updated the audience on how digital progress can influence real-world evidence to allow near real-time data analysis and inclusion of specific patient information, lowering cost and providing higher quality care downstream.

In a Monday panel convened at the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 23rd Annual International Meeting in Baltimore, Maryland, stakeholders grappled with the role that value assessments play—or should play—in US private payer coverage and formulary decisions.

Innovations are transforming healthcare, but these innovations have to align with business models and they still have to be validated before they can improve care delivery, explained Harlan Krumholz, MD, SM, Harold H. Hines Jr professor of Medicine and Epidemiology and Public Health, Yale School of Medicine, and director, Center for Outcomes Research and Evaluation, Yale-New Haven Hospital.

Ilene Hollin, PhD, MPH, the National Pharmaceutical Council and University of Southern California Schaeffer Center’s Postdoctoral Health Policy Fellow, discusses what needs to be included in the next generation of value assessment frameworks in order to best identify value that is representative of all patient preferences.

The United States can benefit from taking and adapting certain elements of European countries’ systems and methods of assessing value, says Patricia Danzon, PhD, the Celia Moh Professor at The Wharton School, University of Pennsylvania.

A one-size-fits-all approach to value is impossible in the US healthcare system, but a pluralistic approach is extremely complex to implement, says Ilene Hollin, PhD, MPH, the National Pharmaceutical Council and University of Southern California Schaeffer Center’s Postdoctoral Health Policy Fellow.

A combination of different countries’ health systems can set an example for the United States to follow in efforts to restrain the ongoing increases in drug prices, explains Patricia Danzon, PhD, the Celia Moh Professor at The Wharton School, University of Pennsylvania.

Patients, payers, and providers all view value in different ways, and they all need to be taken into account in value frameworks, said Ilene Hollin, PhD, MPH, the National Pharmaceutical Council and University of Southern California Schaeffer Center’s Postdoctoral Health Policy Fellow.

There are differences between cost effectiveness and affordability that people don't always understand. A drug may be cost effective but still not fall within the budget, explained Patricia Danzon, PhD, the Celia Moh Professor at The Wharton School, University of Pennsylvania.

Michael Sherman, MD, chief medical officer at Harvard Pilgrim Health Care, discusses the challenges of moving towards performance-based risk-sharing agreements and where they would work best for certain treatments.

Legislators from both parties may have difficulty finding a common solution to high drug prices, but President Donald Trump could be instrumental in bringing prices down if he acts on his pledges, according to David M. Cutler, PhD, of Harvard University.

Health technology assessment (HTA) is a tool that helps to objectively evaluate evidence, which levels the playing field for new therapies looking to demonstrate cost-effectiveness, according to Steve Pearson, MD, MSc, president of the Institute for Clinical and Economic Review. In doing so, stakeholders can better understand the balance between innovation and affordability.

Both political parties want to lower the price of drugs, but differ in how they think it should be done. Gail Wilensky, PhD, of Project HOPE, explained her opinion that spurring more competition would be a more successful approach than directly implementing price controls.

Ideally, researchers determining the clinical and economic effects of a new treatment would have both short-term and long-term data, explained Steve Pearson, MD, MSc, president of the Institute for Clinical and Economic Review. If not all of this data is available, however, they may have to use surrogate outcomes or perform indirect comparisons.

The Trump administration’s healthcare priorities have mainly focused on replacing the Affordable Care Act or reforming Medicaid, leading to concerns that value-based purchasing efforts will be left in the dust, said David M. Cutler, PhD, of Harvard University.

Value-based care strategies will continue to progress no matter who occupies the White House, according to Gail Wilensky, PhD, of Project HOPE. HHS Secretary Tom Price has indicated his support for limited demonstrations, but Wilensky predicts he will continue to push against large-scale mandatory demonstrations.

According to Steve Pearson, MD, MSc, president of the Institute for Clinical and Economic Review (ICER), patient perspectives are critical for determining meaningful outcomes and helping to guide the cost-effectiveness review process.

Differential pricing structures are necessary for products with surrogate endpoints and to account for revolutionizing treatments in order to have a more sustainable value equation, according to Scott Ramsey, MD, PhD, of Fred Hutchinson Cancer Research Center.

As Republicans work to reform Medicaid, they must contend with questions about the appropriate financial support level and the grant structure of the program, according to Gail Wilensky, PhD, of Project HOPE.

Value-based price benchmarks can help payers determine whether a drug’s price aligns with its ability to help patients, which can then facilitate the innovation and uptake of new therapies, said Steve Pearson, MD, MSc, president of the Institute for Clinical and Economic Review (ICER).

There are some areas in health policy where Democrats and Republicans can find common ground, like incentivizing greater value, but bipartisan talks won’t happen while there are still active efforts to repeal the Affordable Care Act, said David M. Cutler, PhD, of Harvard University.

Scott Ramsey, MD, PhD, of Fred Hutchinson Cancer Research Center, discusses determining cost effectiveness of novel treatments, such as immuno-oncology agents, and potential solutions to reducing financial toxicity in cancer care.

As the Institute for Clinical and Economic Review (ICER) prepares to update its final value proposal framework, it has been aided by the constructive comments from different stakeholders, said ICER president Steve Pearson, MD, MSc. He predicts that coming years will see continued interest in how to utilize such frameworks.

The United States just went through a period of low spending growth, and if no one pays attention to it, the country might not be able to figure out what worked to cause this slow growth, said Gail Wilensky, PhD, of Project HOPE.

Senate Republicans are faced with a tall task to create a healthcare bill that repeals the Affordable Care Act because they've made conflicting promises. According to David. M. Cutler, PhD, of Harvard University, Senate Republicans have set themselves up for a situation where they can't meet all of their promises.

The healthcare legislation from Senators Bill Cassidy (R-Louisiana) and Susan Collins (R-Maine) was probably the best chance at a bipartisan bill, but there are some Democrats who still seem interested in drafting bipartisan legislation, explained Gail Wilensky, PhD, of Project HOPE.