The following is an excerpt from an article in the Journal of Clinical Pathways on a panel Dr. Eleanor Perfetto, Executive Vice President, Strategic Initiatives at the National Health Council participated in at ISPOR 2019. Read the full article here.
A panel at the ISPOR annual meeting (May 18-22, 2019; New Orleans, LA) convened for a lively discussion on the “controversial” quality-adjusted life-year (QALY) and whether or not there is a middle ground in the debate.
Led by moderator Jennifer Bright, MPA, executive director, Innovation and Value Initiative (IVI), the panel featured Lou Garrison, PhD, University of Washington; Eleanor Perfetto, PhD, MS, senior vice president, strategic initiatives, National Health Council; and Andrew Lloyd, director, Acaster Lloyd Consulting (UK).
Ms. Bright began the session by posing the question of whether QALY accurately represents patient experiences and captures aspects of value as a “cornerstone of economic analysis.” Dr. Garrison responded by arguing that the shortcomings of QALY need to be addresses. QALY is a good starting point for economic analysis for determining value of medicines, he said, but willingness-to-pay cannot be used for medicines. “I view QALY as a work-around for trying to figure out what value is and what we should reward for innovation,” he stated.
Dr. Perfetto then spoke and disclosed that she was representing the patient and advocacy perspective. She has heard from the National Health Council advocacy membership that patients are being denied care based on what come out of value reports. The Council attempted to address these issues by releasing a rubric to grade whether patient-centered approaches are utilized in various value framework and resulting reports. “A lot of the work we have done in the past in value assessment that use clinical trial data and focus on wrong endpoints are giving us wrong answers,” she stressed, and that these reports are “cherry picked” by payers to determine coverage decisions. Thus, the reports are being used as a “blunt instrument” and not as a factor in decision-making.