ICER’s Collaboration with the Department of Veterans Affairs
In 2017, the Department of Veterans Affairs began integrating ICER’s research into its pricing negotiations to provide greater value to Veterans and taxpayers. At the time, there was some consternation from industry, with the National Pharmaceutical Council asking whether the partnership could simply be “…a means to justify an even more limited and cost-constrained formulary?” But in a new article in Health Affairs, leaders from the VA and ICER look back at the actual impact of the collaboration, revealing that the VA has never used a negative ICER report to limit access to a medication, but instead has used our work to achieve better pricing from manufacturers, while expanding access to the treatments that are most valuable to Veterans and their families. After providing several specific examples, the authors conclude: “The collaboration shows that a health care system in the US can utilize independent cost-effectiveness analyses as an additional information resource to help make more focused clinical and financial decisions. Through this effort the VA has gained an objective, transparent standard to guide its drug price negotiations, and the results have not undermined in any way the clinical focus of the VA drug coverage process. We look forward to a continued collaboration on behalf of our Veterans and US taxpayers in the quest to provide crucial medications at the most reasonable prices possible.”
In 2023, we released a revised Evidence Report assessing the comparative clinical effectiveness and value of lecanemab (branded Leqembi) for Alzheimer’s disease. ICER’s analysis indicated the treatment would achieve common thresholds for cost-effectiveness if priced between $8,900 – $21,500 per year. Lecanemab currently has a list price of $26,500 per year.
According to Pink Sheet, the VA has decided to cover the therapy at a price, “just below the $21,500 cost-effectiveness threshold set by the Institute for Clinical and Economic Review (ICER).” This is a great example of how ICER reports can be used to recommend a fair price, resulting in greater access for patients.
PTSD: Service Dogs
We continued our collaboration with the VA through another project: ICER was commissioned by the VA to conduct an assessment of the cost-effectiveness of service dogs trained in tasks related to post-traumatic stress disorder (PTSD), based on findings from the largest related examination to date conducted by the VA. This randomized clinical trial compared outcomes for veterans with PTSD who were randomized to receive a specially trained service dog or an emotional support dog. The VA presented the key findings of the ICER report to the National Academy of Medicine in 2021 as part of a broader set of monographs evaluating the trial results.