17 April 2019 - The Institute for Clinical and Economic Review is sometimes called America's `NICE,’ referring to the National Institute for Health and Care Excellence in England and Wales. 

In certain ways, ICER and NICE do resemble each another. Both institutes undertake clinical and economic reviews of medical technologies, endorse and utilise the Quality-Adjusted-Life-Year (QALY) in their cost-effectiveness analyses, and make recommendations to payers. Both entities have also been subject to criticism from the drug industry and patient advocacy groups with respect to their methodology and certain controversial recommendations they've made.

In the U.S., ICER is gaining traction, in ways perhaps unimaginable several years ago. For many years it was thought that the U.S. would be immune to cost-effectiveness thresholds. It was common to hear the refrain: "We don't do rationing here, at least not explicitly." Well, explicit rationing is no longer something that's merely done in single-payer systems or international markets. ICER is partly responsible for reintroducing the discussion of explicit rationing in the U.S.. Last summer, CVS Caremark established a formulary based on cost-per-QALY estimates, Specifically, CVS Caremark provided clients the option of excluding drugs from coverage if they don’t meet a benchmark of $100,000 per QALY in analyses carried out by ICER.

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