In our work in health economics and outcomes research (HEOR) for the life sciences, including biotechnology, pharmaceuticals, and medical devices, we must maintain close ties with our colleagues and stay up to date with the latest thinking on methods of technology assessment, trends in coverage decisions, and relevant changes in the policy and economic environment in which economic evaluation takes place. The best place to do this is, of course, the annual U.S. and European conferences of the International Society of Pharmacoeconomics and Outcomes Research (ISPOR). In this blog, we provide some more detail on all of the events we are involved with in this year’s 20th Annual European Conference of ISPOR, Glasgow, November 4-8, 2017.
The Avalon team is especially strong in HEOR methodology and this is best demonstrated by the strong roster of ISPOR courses in which the Avalon team is involved. For example, Avalon Director and Principal Andrew Briggs, DPhil, will be co-teaching Collecting Health-State Utility Estimates for Economic Models in Clinical Studies. Health state utility (HSU) estimates are among the most important and uncertain data inputs in cost-utility models and are increasingly being used to inform health technology assessment, pricing, and reimbursement decisions in many countries. The ISPOR Outcomes Research Guideline, Collecting Health-State Utility Estimates for Economic Models in Clinical Studies has been developed recently by an ISPOR Task Force to help researchers plan the collection and analysis of health utility data in clinical studies in order to provide high quality HSU estimates appropriate for economic. This short course provides an opportunity to review and discuss the content of the guideline, with a view to improving the effectiveness of utility data measurement in clinical studies. The focus will be on optimizing the collection of utility data to provide HSU estimates for economic models. Specifically, the course will address key challenges surrounding study design, data collection and analysis. This will include how to anticipate and address common issues that may affect data quality, alignment with the needs of economic model, acceptability to the model audience, and how to apply good research practices for HSU estimation in future research.
Briggs will also be co-teaching Understanding Survival Modeling with Application to HTA. Time-to-event (survival) analysis is an important element in many economic analyses of health care technologies. This is particularly true in oncology given the requirement to estimate lifetime costs and outcomes (i.e. extrapolate) beyond the follow-up typically observed in clinical trials. Cost-effectiveness estimates can be sensitive to the methods applied in modelling survival data. Recommendations for selecting a parametric survival model have been recently been published; following a review of extrapolation modelling in National Institute for Health and Care Excellence (NICE) technology appraisals. The purpose of this course is to provide participants with an understanding of the fundamentals of survival analysis and key issues to be considered when comparing alternative survival models for inclusion in cost-effectiveness analysis. This will include an understanding of differences between partitioned survival and Markov-based approaches.
Finally, Avalon CEO John Schneider, PhD, will team up with Briggs to teach Introduction to the Economic Analysis of Diagnostics, the third year in a row in which the course has been taught at ISPOR. There has been dramatic progress in the science and applications of diagnostics in recent years, especially in the areas of molecular and genomic diagnostics and personalized medicine. The new generation of tests offers opportunities to improve patient care and treatment outcomes. However, there remain a number of challenges in translating technological advances in diagnostics to improved patient care, and the impact of the new generation of diagnostics on the costs of care and payer budgets is variable. One of those challenges is establishing the economic value of new tests. The economic evaluation of diagnostics follows the same basic structure of any economic evaluation of medical care interventions, but has several important additional considerations, including clinical decision making, test applications, test performance, tested populations, outcome measurement, data, and evidence requirements. This course is designed to expand upon economic evaluation of diagnostic devices, including companion diagnostics, molecular diagnostics, rapid point-of-care tests, and so on. In keeping with the diagnostics focus, at ISPOR Briggs will also take part in a Congress Program Overview entitled A Framework for the Cost-Effectiveness Analysis of Novel Biomarker Testing in Cardiovascular Disease.
Of course, one of the primary focal points of any discussion of economic evaluation is market access and the role of health technology assessment authorities. Avalon’s Briggs has been a key thought leader in European and U.S. health technology assessment, and will be sharing his expertise at two interesting sessions. The first is the Second Plenary Session: Appraising the Appraisers: What Is the Future of Health Technology Assessment in Europe? Health technology assessment (HTA) processes vary across jurisdictions. Some countries are early adopters and include a formal economic evaluation (Canada, United Kingdom, Australia, Sweden, The Netherlands), others have a less arduous approach without formal QALY-type assessment (France, Spain, Italy), and still others prefer to reference HTAs performed elsewhere (Romania, Bulgaria). In addition, bodies such as EUnetHTA offer the potential to streamline processes by enabling information sharing and structured collaboration between jurisdictions. However, how cost-effective are the HTA processes? What is the value for money of the HTA activities? Is there a “perfect HTA process” that can serve as the benchmark for other countries to adopt or adapt? This plenary session will explore how HTA processes (or lack of HTA processes) might be compared and evaluated. The speakers will present different perspectives on evaluating the value of HTA processes and a discussant will provide an economist’s view.
One of the most important areas of technology assessment is oncology, and Briggs will be playing a major role in the session entitled Determining the Value of Long Term Outcomes Associated with Immuno-Oncology Therapies - Challenges and Approaches for OS Extrapolations. Estimating the value of immuno-oncology (IO) treatments is challenging. It is common for the OS benefit to represent a major source of uncertainty due to the immaturity of data from clinical trials. Typically, extrapolation of OS relies on fitting a parametric curve under a set of standard distribution assumptions. The emergence of IO agents and their new mechanisms of action add further layers of complexity to OS extrapolation. The objective of this workshop is to discuss additional challenges in fitting survival models for IO treatments and evaluating emerging approaches to overcome existing challenges from both statistical and clinical perspectives. The workshop will build upon previous workshops held at 2016 and 2017 ISPOR meetings, assessing survival projection methods for IO agents.
-John Schneider, PhD, CEO