Stakeholders raise concerns about ICER’s evidence report for non-small cell lung cancer

The value of recent advances in non-small cell lung cancer (NSCLC) is undeniable. NSCLC is a devastating illness – 17.7 percent of lung cancer patients survive only five years following their diagnosis. However, in the last decade, advances in cancer biology have led to tremendous improvements in treatment. According to the American Lung Association, new targeted therapies are extending life – often without the side effects of chemotherapy, such as fatigue, nausea, vomiting and diarrhea, allowing patients to lead more active and productive lives while in treatment. The organization has said lung cancer patients place a high value on quality of life and the opportunity of medical discovery to extend their lives.

Today, the Institute for Clinical and Economic Review (ICER) will host a meeting in St. Louis, MO, to discuss its evidence report on some of these NSCLC treatments, which multiple stakeholders, including patient advocates and members of the biopharmaceutical industry, have provided feedback on over the last several months. Stakeholders who weighed in on ICER’s assessment of NSCLC treatments appear to have significant concerns about the methods ICER is using to quantify the value of treatments.

Here is what stakeholders are saying:

ICER’s framework does not account for the aspects of value that matter to patients.

“This analysis further demonstrates ICER’s cursory examination of patient impact, and theorizes a health care payment model which does not currently exist … Does the ICER approach appreciate the realities of the disease progression of lung cancer and that only 17.7% of lung cancer patients survive five years?” – American Lung Association

“Lung cancer patients place a high value on quality of life and the opportunity of innovation to extend their lives. We are dismayed that the ICER review fails to recognize the importance of these improvements in their everyday lives that are the result of using these new targeted therapies.” – American Lung Association

ICER’s assessment of NSCLC is in direct conflict with the movement toward personalized medicine.

“The model also proceeds to use population-level data to make patient-level predictions. Such a model is incongruous with the basic tenets of precision medicine and will be detrimental to the lung cancer survivor community. The progress we have seen in lung cancer treatment in the past decade should not be denied to the patient/survivor.” – Lungevity

ICER’s process is not inclusive and does not encourage meaningful input.

“On a very basic level, the instructions you give for submitting feedback are limiting in both feedback opportunity and transparency.” – Cancer Support Community

“The transparency is poor on the assumptions, methods and results for the above mentioned report. A key example would be the non-use of figure legends to explain the derivation of the figures throughout the report. In order for the results to be duplicated, the methods need to be made transparent.” – Lung Cancer Alliance

ICER’s framework, which relies on a QALY-based cost-effectiveness analysis, conflicts with the movement toward personalized medicine.

“CSC understands your use of quality-adjusted life year (QALY) as an endpoint but does not support this as an endpoint which is meaningful to patients … The QALY framework assigns the exact same score to an individual who lives six months in perfect health and to an individual who lives a full year in a debilitated state. Patients would assign a very different level of value to each of these scenarios.” – Cancer Support Community

“… [U]nlike other diseases where QALYs may have some applicability, lung cancer is not a singular disease. Rather, it is a continuum where stage of diagnosis, presence or absence of actionable mutations, recurrence, and end-of-life care would impact a patient’s decision about a treatment option. Using QALYs may not adequately capture what different patients value along the lung cancer continuum.” – Lungevity

Read more about how ICER puts hard-fought progress in NSCLC at risk here.