I very rarely recommend anyone watch or participate in a meeting, so this is a BFD: If you care about cost effectiveness, I recommend that you spend some time watching parts of one or two webcast meetings this week. Here’s why:
Whenever I raise the application of cost effectiveness analysis (or comparative effectiveness) in health care, I get a lot of reasonable push back such as:
- What about heterogeneity of treatment effects?
- What about special populations? Vulnerable populations? Special and vulnerable populations?
- What if this is the only treatment for a rare disease that kills babies? Special, vulnerable populations of babies?
It’s issues like these that lead reasonable people to propose processes that consider cost effectiveness alongside other factors. (It’s my view that it leads unreasonable people to give up entirely on cost- and comparative-effectiveness. Your mileage may vary.)
Consideration of cost effectiveness and other issues, such as those above, is what NICE does. And, here in the U.S., that’s what the Comparative Effectiveness Public Advisory Council (CEPAC) and the California Technology Assessment Forum (CTAF) do too.
People who ask questions like those above are absolutely right to imply that weighing costs, effectiveness, and issues of justice and fairness is exceedingly challenging. Yet, these things can and do get weighed, at least implicitly, by various components of our health system—and likely in no consistent fashion geographically, over time, or across populations or treatments.
CTAF and CEPAC members (of which I am one) struggle mightily to weigh these things in a more deliberative and consistent manner. It’s exceedingly difficult, but worth your time to watch.
So, before you conclude that we just can’t work all this out in some kind of sensible process, take a look at what CEPAC and CTAF do. This week offers two opportunities:
The first will be a meeting of the New England Comparative Effectiveness Public Advisory Council (CEPAC) that will review the report on the PCSK9 inhibitors Praluent® and RepathaTM to treat high cholesterol. The second will be a meeting of the California Technology Assessment Forum (CTAF) that will review the report on treatments for congestive heart failure (CHF) (Entresto™ and CardioMEMS™). […]
On Tuesday, October 27, 2015, the New England CEPAC will meet in Boston, MA to review the PCSK9 report. […] An agenda of the meeting can be found here. […] Attendance for the in-person meeting is at capacity, so those wishing to hear the meeting should register for the live webcast of the event by clicking here. A video recording will be available on the website the week after the meeting.
On Thursday, October 29, 2015, CTAF will meet in Oakland, CA to discuss the CHF report. […] An agenda of the meeting can be found here. […]
A limited number of seats are still available for members of the public who wish to attend the CTAF meeting […]. Members of the public may register by clicking here, those unable to attend the meeting in-person may register for a live webcast of the event by clicking here. A video recording will be available on the website the week after the meeting.
If you can only spend a short amount of time watching one (or both) of these meetings, I recommend you focus it on the evidence review, deliberations, and voting. I don’t mean to short change the policy discussion, but I’d add that only after you see the other parts of the process.