The Account Keeper

ICER: Seeking Value in Obesity Medicine

We’ve all got our reading assignments. The Institute for Clinical and Economic Review (ICER) has released its draft report on effectiveness and value for the current options in obesity medicine. There’s a lot to process in there. But the bottom line is clear enough. Phentermine/topiramate (Qsymia) offers the best value, says the report. The most innovative and effective drug available (semaglutide) is priced too high to meet common thresholds for cost effectiveness. According to the report:

“Semaglutide does not meet typical cost-effectiveness thresholds but is more effective, less burdensome, and more cost effective than liraglutide.

“Semaglutide might be considered in patients not achieving desired weight loss or unable to tolerate phentermine/topiramate or bupropion/naltrexone, but only with a significant discount.”

A Work in Progress

Even if we do not agree with everything in this report, it represents an impressive effort. In the past, ICER has received criticism for not reflecting input from clinicians and patients on the need for innovative therapies. In developing this report, though, the group seems to have made considerable effort to overcome that criticism.

Early in their process, they reached out to a wide range of organizations (including ConscienHealth) to obtain input. The Obesity Action Coalition helped them arrange a focus group with patients who could illustrate “a diversity of experiences” living with obesity.

Focus groups have their limitations, but at least ICER is trying to live down its reputation for caring about nothing but money.

Working Through the Details

As we’ve said, this is a report dense with information, based upon modeling that is not totally intuitive at a glance. Some of it makes sense. For instance, liraglutide for obesity (Saxenda) seems to get a failing grade here on value. ICER estimates that it’s not as effective as phentermine/topiramate. But it costs eight times more. Arguing with ICER’s finding on this would seem pointless.

On the other hand, it’s hard to reconcile the report’s assertion that semaglutide should rarely be used with real world experiences of patient lives transformed by its remarkable effectiveness.

Models like this are tricky. This is only a draft report. Everyone who cares about this subject should read it carefully, check the work and the assumptions that drive it, and provide comments in the public review process that starts now. This is work that can play a big role in access to care for innovative medicines. Value surely matters when payers make decisions about obesity medicine.

Click here for the draft report, here and here for further reporting on it. For information from ICER on this report, including how to submit comments or register for the September 16 public meeting on this subject, click here.

The Account Keeper, painting by Nicolaes Maes / WikiArt

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July 14, 2022