Surfing the MASH Tsunami

S4-E12.2 - ICER Draft Report: Assessment of Disease Prevalence and Prospective Drug Efficacy

HEP Dynamics Season 4 Episode 12

Last week, Jeff McIntyre of the Global Liver Institute introduced a draft report from the Institute for Clinical and Economic Review (ICER) on resmetirom and obeticholic acid for NASH. Jeff, an expert reviewer of the report, returns with the Surfers to expand on the contents, its shortcomings and potential implications. Among the panelists are Veronica Miller of the Liver Forum and new guest, Hannah Mamuszka, who is founder and CEO of Alva10.

Hannah begins this conversation by asserting that the report “understates the problem of the size of population we’re talking about.” She notes that it fails to consider the strength of data linking NAFLD and NASH to cardiovascular disease, liver cancers and even extrahepatic cancers. Hannah goes on to outline the relevant questions of commercial payers in the assessment of prospective pharmacotherapies: 

  • What is the size of the patient population and what is going to be the effect of coverage in terms of how many patients are we going to prevent from progressing to liver transplant? 
  • How many patients are we going to keep out of the hospital with chronic events?

Ultimately for Hannah, the analysis by ICER misses much of the potential cost savings of an effective drug. Louise echoes concerns surrounding the “difficulty in the communication and the language used throughout the report.”

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