Comparative clinical effectiveness assessments play a crucial role in healthcare decision-making. This analysis compares the Institute for Clinical and Economic Review (ICER)’s ratings with those of the German Federal Joint Committee (G-BA), focusing on instances where both organizations evaluated the same drugs for the same indications and patient populations. The objective is to identify discrepancies and understand the underlying reasons for disagreement.
Methodological Approach to Comparing ICER and G-BA Ratings
The study included drugs assessed by both ICER (using its 2020-2023 Value Assessment Framework) and G-BA (as of January 2024) with consistent indication, patient population, and comparator drug. A modified version of ICER’s proposed crosswalk between G-BA and ICER benefit ratings, incorporating G-BA’s certainty ratings, facilitated comparison. The evidence base for each assessment pair was also examined for similarity. Pairs exhibiting disagreement despite similar evidence underwent qualitative analysis to pinpoint the sources of discrepancy.
Unveiling Discrepancies in Comparative Effectiveness Assessments
Fifteen drug assessment pairs met the inclusion criteria. Surprisingly, none demonstrated complete agreement when based on a similar body of evidence. The disagreements stemmed from variations in evidence evaluation, encompassing safety assessments, generalizability considerations, and study design critiques. Significantly, in four instances, G-BA deemed the available evidence unsuitable for assessment.
Figure 1: Disagreement in comparative effectiveness assessments between ICER and G-BA, even with similar evidence bases.
Implications for International Harmonization of Value Assessments
This comparative analysis highlights the subjective nature of comparative effectiveness assessments. Even with identical populations, comparators, and consistent evidence, different assessors can reach divergent conclusions. This underscores the inherent presence of value judgments within such assessments.
Figure 2: Transparency in value judgments is crucial for international collaboration in healthcare assessments.
For successful international exchange and harmonization of value assessments, transparent presentation and justification of these value judgments are paramount. Detailed summaries should explicitly articulate the rationale behind assessment decisions, fostering clarity and facilitating informed decision-making across diverse healthcare systems. This transparency is essential for building trust and enabling meaningful comparisons of value assessments across countries. Future research should further explore the specific value judgments driving these discrepancies to improve cross-national understanding and collaboration in healthcare evaluation.
