ICER prioritizes its assessments of medical interventions to focus on those which have a major impact on system-wide health care quality and costs.  ICER reviews may be particularly useful when a clear understanding of the clinical and economic impact of an intervention requires analysis of downstream effects on patient care and utilization.  Importantly, ICER reviews and its rating system are also framed to compare interventions in clinical domains in which it is believed that patients and clinicians have choices among reasonable alternatives.  Thus ICER reviews can support efforts to extend the concept of tiered formularies to medical procedures, devices, and biologics.  When reasonable choices exist, purchasers, patients, and clinicians are more open to evidence-based medical policies that encourage a value-based approach.

The ICER review process proceeds in three phases:

• Scoping committees are formed for each assessment, consisting of clinical experts, patient representatives, experts in evidence-based medicine and health economics, and manufacturers.  The scoping committee frames the key questions of each assessment, including identifying the appropriate comparator technologies, important patient subgroups, time horizon for the analyses, and other parameters as necessary.  

• The technology assessments are then conducted through a combination of internal staff work and external collaboration with other academic sites.  Comparative clinical effectiveness is assessed through systematic review of the medical literature, interviews with clinical experts, and discussions with health system leaders.  Meta-analysis, decision modeling, and other quantitative methods are used where appropriate.  Comparative value is assessed on the basis of an economic model whose assumptions are made transparent to all stakeholders.   ICER appraisals integrate these two assessments in a series of graded categories which form the ICER Integrated Evidence Rating™.

• Draft appraisals are presented to an independent Evidence Review Group (ERG).  The ERG consists of experts in evidence-based medicine, health policy, health economics, clinical practice, and ethics; they also include patient representatives. The role of the ERG is to provide multiple perspectives on the review of the draft appraisal, and to advise ICER on the assignment of the Integrated Evidence Rating for each technology. 

Technology Appraisal Process Flow