The Institute for Clinical and Economic Review (ICER) is a non-profit organization that weighs the costs of prescription drugs against their clinical and social value. Their method is complex, but essentially it designates drugs as "high value" if they deliver an additional, quality-adjusted life year (QALY) for less than $50,000, and "low value" if the ratio of price to QALY is greater than $175,000.

In between $50,000 and $175,000 per QALY, ICER assembles a committee of clinicians, economists, and patients' advocates to judge a drug's value based on a review of the quantitative and qualitative evidence.

An analysis of committee members' votes finds that a drug's potential to improve productivity can help tip its assessment towards "high value."

[…] Committee members in seven cases voted for either “high value” despite unfavorable cost-effectiveness, or for “low value” despite favorable cost-effectiveness.  Factors cited in various published ICER assessments for these “high-value discrepancies” (i.e., votes for high value despite unfavorable cost-effectiveness) included reduced caregiver burden, improved productivity, and disease severity [emphasis added].

This insight drives home the importance of including real world productivity outcomes—such as sick day absences and disability leaves, but also assessments of impaired job performance and systematically collected, first-person accounts from patients—when making the business case for effective care.

IBI's recent review of the research literature linking medication adherence to lost work time underscores that evidence for the business value of high-quality care exists. However, more evidence, and of higher quality, is still needed. Going forward, productivity outcomes should become routinely evaluated for any new therapies that are being brought to market.

Without that piece of the puzzle, decisions about investments in workforce health will continue to focus on costs rather than on value.

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