Biotechnology Healthcare - July/August 2008 - (Page 29)

No shortage of ideas on what CER should look like What employers want National Business Group on Health What should it look like? No new organization, but rather a body that oversees studies Blue Cross and Blue Shield Association A new “institute” chartered as an independent, private entity What payers want Medicare Payment Advisory Commission (MedPAC) An independent entity; MedPAC prefers a publicprivate option Cost-effectiveness is not a primary mission, but MedPAC does not rule out making such analyses, particularly when two services are equally effective in a given population What biologics industry wants America’s Health Insurance Plans A national publicprivate partnership Biotechnology Industry Organization Does not address Should costeffectiveness be part of CER? Costs should be Does not address considered only after clinical effectiveness studies are completed Cost-effectiveness should be addressed simultaneously with clinical effectiveness Comparative effectiveness information should not be used strictly as a means to contain costs; CER studies should consider all aspects of disease and treatments, including increased worker productivity and savings to all parts of healthcare system CER should inform clinical judgment and individual needs in medical decision making, as opposed to illustrating the experience of the “average patient on the “average” course of therapy If CER is used in coverage decision making, payers should consider overall value of a therapy and allow for individual patient variation, rather than just consider cost; it should be applied to advance personalized medicine and development of targeted therapies CER should focus on totality of healthcare system, including preventive services, diagnostic tests, and medical procedures, rather than just drugs and biologics What should it cover? CER should address all healthcare treatments, including pharmaceuticals, devices, medical and surgical procedures, and other interventions Governance should assure accountability in the conduct and dissemination of CER CER should support a broad range of research, especially clinical trials CER should compare clinical and cost-effectiveness of new and existing drugs, devices, procedures, therapies, and other healthcare services It should re-examine the comparative effectiveness of interventions over time How should CER information be used? Significant education and incentives are needed to ensure new research improves clinical practice The entity should distribute CER information in a useful format so patients and clinicians can make more informed healthcare decisions “The entity should disseminate information to providers, patients, and public and private health plans. It should have no role in making or recommending coverage or payment decisions for payers.” What else? Medicare and other public programs should be required to consider the institute's research in developing payfor-performance, coverage, reimbursement, and other key policies BIOTECHNOLOGY HEALTHCARE analysis decade. The biggest beneficiary would be the federal government, which would save $113 billion, fol- lowed by households that were spared $107 billion in unnecessary healthcare outlays, and private pay- ers, which would save $97 billion. In a 2008 multiparticipant audioconference discussing CER, Stuart JULY/AUGUST 2008 · BIOTECHNOLOGY HEALTHCARE 29

Table of Contents Feed for the Digital Edition of Biotechnology Healthcare - July/August 2008

Biotechnology Healthcare - July/August 2008 Openers Contents Editorial/David B. Nash, MD, MBA Drug Track Health Plan Confidential Rheumatoid Arthritis A Decade of Trial, Error, False Starts, and Hope What Path Will Comparative Effectiveness Research Take? RA Therapies in Development: A New Generation of Relief Assessing the Full Impact of RA on Employers and Payers Stem Cells: Health Insurance You Can Bank On Specialty Pharmacy Employer to Employer Personalized Medicine Trends Clinical Briefs

Biotechnology Healthcare - July/August 2008

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