The Innovation and Value Initiative (IVI) has issued the following statement in response to the Institute for Clinical and Economic Review (ICER)’s recently published white paper, “Advancing Health Technology Assessment Methods that Support Health Equity.”

IVI commends some of the practical learnings and supports ICER on the exploration of how “[health technology assessment] HTA can support society’s goal of health equity improvement for racial, ethnic, and other socially disadvantaged groups,” addressed in the report. However, fundamental change to the conduct of HTA is necessary to advance health equity. Incremental or small adjustments will not reduce existing disparities or prevent further inequities in healthcare access or outcomes for patients.

Moving forward, IVI recommends that ICER considers the proposed methodological changes, engagement strategies, and gaps in the report. These include, but are not limited to the following:

  • Engaging patients and patient group in the HTA process.
    • For true engagement, HTA programs must incorporate patients as equals on HTA evaluation teams by including them in the selection and scoping of topics, not just in advisory positions.
    • An inclusive, transparent, and participatory process with a large and diverse set of stakeholders, especially those with lived experience, would offer a great deal of opportunity for feedback.
  • Evaluating the diversity of participants in clinical trials.
    • While admirable that ICER would like to evaluate clinical trial diversity, this appears redundant as the U.S. Food and Drug Administration (FDA) already has begun this endeavor by creating a patient engaged advisory body to promote transparency, patient-centricity, and accountability. Clarification of how ICER’s Sample Diversity Ratings will be evaluated into overall assessments could provide additional transparency.
  • Measuring the opportunity to reduce health disparities.
    • Mixed methods, including quantitative and qualitative analyses, should be considered as part of a deliberative process used in HTA by learning from methods use din other research areas.
  • Promoting health equity through quantitative methods and cost-effectiveness analysis.
    • Accountability for equity-related data collection and incorporating this data into assessments is a necessity. We strongly encourage ICER to consider sensitivity or scenario analyses using plausible ranges when the preferred data is not available.

We appreciate ICER’s intentions, but without proper incorporation of patient engagement, diversity, and a mixed method approach, the results do not solve the problem of cultivating health equity within HTA. We challenge our community to continue advancing research to make health equity an integral part of HTA methodology and the entire HTA process.

To learn more about IVI’s Health Equity Initiative, read our recently released report, “Health Equity Initiative (HEI) Update: Synthesis of Cross-Stakeholder Insights.”


About IVI
The Innovation and Value Initiative (IVI) is a 501(c)(3) tax-exempt, non-profit research organization dedicated to advancing the science and improving the practice of health technology assessment through development of novel methods and the creation and application of enhanced health technology assessment models to support local decision-making needs in healthcare.

Contact: Smita Sanwardeker
Phone: 267.909.7661