Objections to the use of cost-effectiveness analysis in the US: reflecting on 'Has the time come for cost-effectiveness analysis in US health care?'

Can We Develop Sustainable and Sharable Cost-Effectiveness Models for Value Assessment in the U.S. Health Care System?

There is currently a movement to make economic models more transparent, with some arguing for completely open-source models. However, increasing model transparency raises several logistical challenges, including ownership and funding. This article outlines recent experience and approaches to some of the logistical hurdles that must be overcome in pursuit of more transparent economic models. The Institute for Clinical and Economic Review (ICER) has recently completed a pilot transparency initiative that made drafts of executable economic models available to involved drug manufacturers during the review process. By directly viewing and interacting with models' structures, inputs, key assumptions, and results, stakeholders were better equipped to provide valuable feedback as part of the health technology assessments. This experience, along with feedback received from the modeling collaborators and relevant manufacturers during this pilot, have helped determine ICER's approach to sharing economic models associated with ongoing and future evidence reviews. This process has been expanded to all assessments going forward, making it the standard approach to model transparency. DISCLOSURES: No outside funding supported the writing of this article. Both authors are employees of the Institute for Clinical and Economic Review (ICER), which is an an independent organization that evaluates the evidence on the value of health care interventions. ICER receives grant funding from the California Healthcare Foundation, Laura and John Arnold Foundation, and New England States Consortium Systems Organization. ICER's annual policy summit is supported by dues from Aetna, AHIP, Allergan, Alnylam, Anthem, AstraZeneca, Biogen, Blue Shield of California, Cambia Health Services, CVS Caremark, Editas, Express Scripts, Genentech, GlaxoSmithKline, Harvard Pilgrim Health Care, Health Care Service Corporation, Health Partners, Johnson & Johnson, Kaiser Permanente, LEO, Mallinckrodt, Merck, National Pharmaceutical Council, Novartis, Premera, Prime Therapeutics, Regeneron, Sanofi, Spark Therapeutics, and United Healthcare.