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LCA Provides Final Comments on Value of Treatments for Lung Cancer

November 3, 2016--The Institute for Clinical and Economic Review (ICER) released its Final Evidence Report on the clinical effectiveness and value of PD-1 immunotherapies and tyrosine kinase inhibitors (TKIs) for the treatment of advanced non-small cell lung cancer.  Lung Cancer Alliance (LCA) has been closely monitoring this process and providing written and oral comments throughout the review that has been underway for the past several months.  
Early on we raised concerns that ICER was not sufficiently engaging patients, survivors and clinical experts in the process to best determine value based care.  We also expressed concern with the data and methodologies that were being used to derive net health benefits, costs and other contextual considerations on effectiveness and value of treatments.  We made it clear that any misapplied or premature judgements on these treatments could place barriers to access, limit choices and adversely impact quality of life.  We raised these concerns because the report would carry weight in policy discussions focused on reshaping health care delivery systems. 
We appreciate that the intent of ICER’s work is to stimulate productive conversation between all stakeholders to find solutions that will help as many patients as possible benefit from treatments without “breaking the bank”.  And we agree with ICER that we must continue to strive for a more efficient and effective health care delivery system that is valued by people.  
Yet we must ensure that in a rush to offer recommendations to advance improvements that we don’t set back current momentum driving us toward more individualize, precise and targeted treatment strategies that uniquely address a patient’s care needs.  The “art of medicine” is best left in the hands of doctors and patient who will know best what therapies – or combination of therapies – are valued most to them. 
LCA must reiterate again its concerns with ICER’s final evaluation of PD-1 agents which found low or intermediate value of these therapies relative to their current price.  We believe that such a determination is wildly premature.  At the time of ICER’s analysis, some of these PD-1 agents considered were not yet approved for the indications they were evaluated under. 
The scientific questions surrounding these therapies far outnumber what we know about treating this disease and deserve time to be utilized in a population based setting – not just clinical trial environment.  Sufficient time to identify and assess the right patient population for these drugs will, in turn, improve value and cost effectiveness.  Only then can cost-effectiveness and value can be better considered and understood.    
LCA remains committed to working with all stakeholders to ensure there is equitable access to the most promising treatments for those who need them most.