Aligning to the ICER reference case
ICER's 2023 Value Assessment Framework specifies a healthcare-sector base case and a modified societal perspective scenario, lifetime horizon, 3% discounting, and both QALY and evLYG outcomes. CEAs that don't report all of these elements get rebuilt by ICER's modeling team — usually less favorably.
Submit your model in the reference-case format even if your internal commercial model uses different assumptions. Provide the commercial scenario as a sensitivity.
evLYG and disability discrimination
Equal-value life-years gained applies the same value to a year of life regardless of baseline quality of life. ICER reports both QALY-based and evLYG-based incremental cost-effectiveness, and policymakers increasingly cite the latter.
For interventions in populations with lower baseline utility (chronic disability, severe rare disease), evLYG materially improves the value story. Report it prominently.
The critiques ICER files most often
Optimistic extrapolation of treatment effect beyond trial duration. Pre-empt with multiple parametric survival fits, external validation against registry data, and a 'waning of effect' scenario.
Under-counted adverse events and discontinuation. Build the discontinuation arm from real-world persistence data, not trial discontinuation.
Unsupported productivity offsets. Limit productivity claims to the modified societal scenario and cite source data explicitly.
Key takeaways
- Submit in the ICER reference-case format; keep the commercial model as a scenario.
- Report evLYG prominently — especially for populations with lower baseline utility.
- Pre-empt the three recurring ICER critiques: effect extrapolation, real-world discontinuation, and productivity offsets.
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