CER Daily Newsfeed

Value Viewpoint: December 12, 2025

(12/12, Kimberly Westrich, LinkedIn) comments “A new analysis published by the Center for the Evaluation of Value and Risk in Health (CEVR) examines whether traditional cost-effectiveness analyses (CEAs) align with the real-world value as reflected by ‘successful’ drugs, defined in the paper as reaching more than $1 billion in global sales within seven years of U.S. launch...The authors conclude: ‘the finding that market value can frequently exceed the value implied by traditional CEA – and the possibility that it may better align with societal preferences – is important. It suggests that modelers and assessors should explore, in sensitivity analyses, additional value elements that might contribute to these differences.’” Full

Technology Is Redefining Data Collaboration in Value-Based Care

(12/15, Benji Feldheim, American Medical Association) reports “...[Mid-Atlantic Permanente Medical Group’s] architecture for value-based care starts with a simple equation: value equals high-quality outcomes and strong experience divided by total cost of care. Better quality and service experience increases value for patients at MAPMG. Meanwhile, non-value-added increased cost of care which results in higher health insurance premiums and decreases value for our patients. But expressing value through the symbol of a mathematical equation is not enough. Leaders must ensure the data behind each component is both clinically meaningful and operationally credible.” Full

From MSSP ACOs to Employer Value: Translating Value-Based Principles to Self-Insured Plans

(12/12, Peter Derrick, BA, The American Journal of Managed Care) comments “...Value-based care (VBC) models, notably the Medicare Shared Savings Program (MSSP), have demonstrated potential for success when stakeholders are aligned and incentivized with cost and quality goals. To illustrate the point, in 2024, the program produced more than $6.5 billion in gross savings, with the 476 participating accountable care organizations earning $4.1 billion in shared savings payments. Even with the success of savings within VBC, adoption within the employer-sponsored insurance market, particularly among self-insured entities, remains limited. Barriers include misaligned financial incentives, fragmented data across vendors, and operational complexity.” Full

UK Pharma Policy at a Turning Point: NICE Threshold Reform, VPAG, and Global Trade Signals

(12/15, Stephen Ralston, PharmaPhorum) reports “...The ICER threshold increase is expected to allow an additional three to five medicines or indications each year to be recommended for NHS use. The new thresholds will apply from April 2026, covering both new technology appraisals and those currently underway...Notably, there has been no public consultation on this change. Public consultation is a routine step in how NICE usually make changes to how they operate and make decisions; the change would appear to have been driven by the UK government (and not by NICE themselves) in response to UK disinvestment decisions from major pharmaceutical companies in response to the stalling VPAG negotiations and pressures created by the Most Favoured Nation (MFN) US drug pricing initiative.” Full

EU Health Data Space Signals Major Shift in Care

(12/15, Ute Eppinger, Medscape) reports “...A core element of the EU HTA is ‘comparative effectiveness,’ which evaluates the value of a new medicine relative to the existing standard of care. This assessment requires an accurate understanding of the existing treatment landscape; however, the standards differ widely. ‘The standard is the same only when there has been no new medicinal product in the last 20 years,’ [Bernhard Wörmann, MD] explained. However, for dynamic conditions, such as leukemia, lymphoma, or multiple myeloma, for which more than 10 new medicinal products have emerged, the standard depends on whether the preceding product is available in each country.” Full