CER Daily Newsfeed

Value Viewpoint: April 24, 2026

(4/24, Kimberly Westrich, LinkedIn) comments “...New research published in Health Economics Review examines why conventional cost-effectiveness analysis can be a poor fit for drugs treating severe rare diseases...Several HTA bodies have added special pathways, higher thresholds, contextual factors, or broader value elements to better address rare diseases, but this study finds that those changes are inconsistent and often leave the core CEA framework intact. Proposed alternatives such as equity weighting, societal willingness-to-pay, MCDA, disease-specific outcomes, and broader value frameworks could better reflect holistic value, but would require clearer standards and closer collaboration among payers, manufacturers, clinicians, and patient groups.” Full

Moving From Aspirational to Operational Engagement of Patients in Healthcare Decisions

(March/April 2026, Rob Abbott, Value & Outcomes Spotlight) comments “...Traditionally, health economists have defined value based on clinical effectiveness and cost-effectiveness, as reflected in the oft-cited (and sometimes maligned) QALY. When patient experiences are incorporated into notions of value, the concept becomes broader, multidimensional, and more patient-centric. Suddenly, we lift our gaze from a singular focus on outcomes such as survival, disease progression, and clinical biomarkers to consider outcomes that matter in daily life, such as the ability to work or attend school, independence in daily activities, emotional well-being, and social participation—the simple, regular things that shape an individual’s life.” Full

A New Medicare Program That Uses AI for Prior Authorizations Is Hurting Patients and Delaying Care

(4/27, Jessica Hall, MarketWatch) reports “...The program - known as the Wasteful and Inappropriate Service Reduction (WISeR) model - requires additional approvals for more than a dozen medical procedures...‘Procedures that were typically completed within two weeks prior to WISeR now take four to eight weeks. That frequently forces patients to reschedule care multiple times, prolonging pain and allowing underlying conditions to worsen,’ [U.S. Sen. Maria Cantwell] said in the letter...‘This model incentivizes WISeR contractors to weaponize AI-driven medical determinations not for the sake of efficiency, as it could be used, but for the opportunity to maximize profitability,’ Cantwell said in the report.” Full