Institute Finds Heart Device Far Too Costly

First it was the cost of Hepatitis-C antivirals, then that of the cholesterol-lowering PCSK9 inhibitors. Today the Institute for Clinical and Economic Review (ICER) has taken on the prices of two treatments for congestive heart failure (CHF).

ICER, a small non-governmental, private non-profit in Boston, issued a negative evaluation of the cost-effectiveness of the CardioMEMS system, a medical device meant to help manage congestive heart failure (CHF). Its draft report is here.

The organization also evaluated the cost and potential budgetary impact of sacrubitral/valsartan (Entresto/Novartis). The drug got FDA approval July 7, 2015.

The ICER goal is to “calculate a value-based prince benchmark for each intervention,” one that will “reflect how much better the interventions are at improving patient outcomes, tempered by thresholds at which additional new costs would contribute to growth in health care costs exceeding growth in the overall national economy.”

Its analysis of CardiMEMS, a $17,750 device that monitors increases in pulmonary artery pressure as a way of predicting the course of CHF, came to the conclusion that there is not enough evidence the device improves patient outcomes.

By ICER’s calculations, that means the device is worth about 60% less that its manufacturer’s price or $7,622.

As for the CHF drug combo Entresto, ICER decided the $4,560 cost per patient per year was more reasonable. It found Entresto “increases the average length of life for patients and also decreases the number of hospitalizations.” But since there are nearly 2 million CHF patients in the US who might take the medication for at least five years, the cost would place “excessive cost burdens on the overall health care system." The ICER report recommended Entresto be discounted by 17%, to an annual per-patient cost of $3,779.

As a private non-governmental organization ICER has no regulatory or legal authority. It was founded in 2006 by Boston internist Steven D. Pearson, MD, MSc, and gets grants from other entities that want technological/economic assessments. Pearson was formerly a senior fellow at American’s Health Insurance Plans, a trade group in Washington, DC.

Considered an expert in health services research, he has also been an advisor to the Centers for Medicare and Medicaid Services.

According to its IRS 990 forms, ICER—the business name for the organization called Evidence for Healthcare Improvement-- in 2014 had gross revenues of $2.4 million, up from $438,000 the previous year, mostly from grants.

Its recent cost analysis reports have garnered much press in mainstream media, including Reuters, the Wall Street Journal, The New York Times and others. According to ICER’s website, its next report will be an evaluation of the cost/benefit/price of lumbar fusion procedures, due in November, 2015.