Author: Dr Paul Langely

ICER Fantasy

THE ICER FANTASY

Dr Paul Langely 1746 Views

In the US, the Institute for Clinical and Economic Review (ICER) occupies a special, if not a unique position in promoting economic evaluations of pharmaceutical products that are entirely imaginary. This is not an unusual event. Through ICER’s embrace of the approximate information meme that has dominated health technology assessment for the last 30 years, it is merely trying to emulate agencies in single payer health systems such as the National Institute for Health and Care Excellence (NICE) in the UK who

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The Mystical Viral QALY

THE MYSTICAL VIRAL QALY

Dr Paul Langely 1653 Views ,  , 

Richard Dawkins in his best seller A Devils Chaplain describes a meme as a mind virus. In common with a computer virus a meme can transmit or propagate from one individual to another with high fidelity if two conditions are met: a readiness to replicate information accurately (ISPOR practice guidelines; textbooks as primers for building imaginary models) and a readiness to obey instructions encoded in the information (education programs, graduate studies, sitting at the feet of the leaders in technology assessment). A

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Assumptions and Models

ASSUMPTIONS AND MODELS

Dr Paul Langely 1540 Views

The lack of appreciation by those involved in the creation of imaginary value claims in health technology assessment is not only a lack of appreciation of the need to meet the standards of normal science, including the axioms of fundamental evidence but also a failure to appreciate the role of assumptions in creating models; models which should be abandoned unless a case can be made that the modeling is short term and the value claims empirically evaluable. The focus on imaginary models

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Fundamental Measurement

FUNDAMENTAL MEASUREMENT

Dr Paul Langely 1576 Views , 

Looking back over the past 40 years, to include the 1980s when the multiattribute instruments were being developed, and consequently, with the smorgasbord of disease specific PROs with many claiming to capture quality of life in that disease state, there is little if any recognition of any understanding of fundamental measurement and the limitations imposed by the respective axioms. The result was a foregone conclusion, which was noted at the time by measurement theorists, that the various instruments would be restricted to

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Nonsense on Stilts

ICER: NONSENSE ON STILTS

Dr Paul Langely 1631 Views

It is unusual for a discipline if that is the right word, to survive and thrive for over 30 years where the principal product is a framework for creating imaginary value claims for pharmaceutical products. Yet this is the situation that health technology has been promoted, and continues to promote, through professional associations such as the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) with organizations such as the Institute for Clinical and Economic Review. (ICER) and the National Pharmaceutical Council (NPC).

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