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Dr Clifford Goodman Outlines Takeaways From a Health Economic Case Study on Repatha

During an industry workshop at the Academy of Managed Care Pharmacy Annual Meeting in Denver, Colorado, Cliff Goodman, PhD, of the Lewin Group, moderated a session that provided a health economic case study on cardiovascular outcome data for Repatha (evolocumab), the PCSK9 inhibitor from Amgen.
Stakeholders have different ideas of what value is, so what factors should drive value assessments?
We must recognize that different stakeholders necessarily have different economic perspectives; there is no one right perspective on value. Value looks different form the standpoint of a patient, a healthcare provider, a payer, and society.
Every stakeholder should consider their own perspectives regarding clinical impact, economic impact, and other implications. Every stakeholder should consider: Who are my target users? What information do they need to make a well-founded decision? And with regard to clinical impacts, maybe we care about individual and/or population clinical impact.
With regard to economic impacts, we care about anything ranging from patient out-of-pocket costs to national healthcare expenditures. So there’s a range of clinical-economic impacts, as well as certain other implications about which we care.
By the way, other implications may include such matters as equity, impact on the broader strength of a regional or national economy, and potential impact on willingness to innovate. So those may be taken into account as well. And also, another implication to put in there is ability to meet unmet medical need.
What is industry's role in identifying value and cost-effectiveness?
As was made clear from this session, it is increasingly apparent that industry needs to be smart about anticipating the decision-making needs of its markets. And by doing that, industry can think early about what types of clinical and economic data need to be generated to influence, to inform and favorably influence, key decision makers.
Furthermore, in addition to this anticipation function, industry can, in some instances, help to educate and help inform decision makers about various biomedical, economic, and analytical matters that decision makers may not otherwise have known. So there’s the anticipation function: who’s going to want what evidence, when?
And the other thing is, in some instances, industry can help educate informed decision makers so they will make better evidence-based decisions.
How do you expect the new administration in the White House will impact the move to value in healthcare?
I cannot speak to the specifics of the new administration on this issue; however, we see that leaders in the executive and legislative branches are calling attention to and scrutinizing some high-profile costs in healthcare and healthcare technology, including pharma and bio. And these leaders may benefit greatly from taking a broadly informed view about multi-stakeholder perspectives on value as opposed to only price tags on individual products and technologies. It’s not just about the price tag; it’s certainly relevant, but it’s certainly one in multiple dimensions of healthcare.
Any last points from the workshop?
The session helped demonstrate that industry is listening and learning about what its markets value and is, by example, hearing in this session, is indeed generating primary and secondary data, including clinical economic, to help suppose those value assessments—industry is already responding.
Furthermore, we are seeing that the organizations in the United States that are taking different approaches to assessing value are increasingly aware of the need to modify, and continue to approve their methodologies for value assessment, including making certain improvements that had been suggested by industry.
The session helped illustrate that industry and value assessors are listening to each other and are trying to improve their approaches accordingly.

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