Messages from the ISPOR Presidents

Jon Clouse, RPh, MS

Jon Clouse, RPh, MS

2000-2001 ISPOR President


About three to four years ago, there was much discussion among ISPOR members regarding the results of several published surveys indicating that, in spite of the fact that organizational purchasers of pharmaceuticals (such as governments and managed care organizations) were specifically requesting pharmacoeconomic and outcomes information, the results of such studies were, with a few exceptions, infrequently used as part of purchasers' decision making processes with respect to formulary position or level of drug accessibility. The unfamiliarity of physicians and other decision-makers with the study methodologies and the lack of transparency of analyses inhibited inclusion of pharmacoeconomic and outcomes research study results with other evidence used in decision-making.

About a year earlier, ISPOR had sponsored seven "Issues Panels", one of which dealt with the topic "Application of Pharmacoeconomic and Outcomes Research in Health Care Decision Making." This panel had reached similar conclusions to those of the published surveys and recommended that ISPOR take action to remedy the situation.

Two key strategic planning sessions followed and the ISPOR Board, Committee Chairs, and interested members determined that ISPOR should devote resources to address this issue. However, this was to be done only if it could be accomplished without any reduction in ISPOR's commitment to the science and methods used by its members in their research work.

That this commitment to science has been kept is amply illustrated by ISPOR's support of the ongoing Health Science Task Forces on Good Research Practices. Additionally, the quality of presentations at this year's Annual Meeting provides further testimony of ISPOR's continuing commitment to science and methodological improvements.

The recommendations from the previously mentioned ISPOR strategic planning sessions lead to the initiation of outreach activities collectively known as "Bridging the Gap." It was unclear exactly what ISPOR should or even could do to bridge the apparent information, communications and priority gaps that existed between those who produce pharmacoeconomic and outcomes research and health care decision makers. There was however, a sense that the gap was large. ISPOR Past-President Bryan Luce referred to this gap as a "chasm."

ISPOR has made much progress toward "Bridging the Gap," but we have only made a start. ISPOR has connected with other organizations that, as organizations themselves, or through their members or employees, influence decisions regarding health care treatment availability and usage and reimbursement. I would like to detail activities with some organizations with which ISPOR has begun active communication to "Bridging the Gap" over the past year.

Rx Health Value - a not-for-profit healthcare organization whose primary mission is to help employers, providers, insurers and consumer groups evaluate new prescription drugs, compare the effectiveness of existing drugs and enable physicians and patients to make informed prescribing decisions. ISPOR met with John Golenski, Executive Director, to discuss initiatives of common interest.

Rx Intelligence - a Blue Cross/Blue Shield drug cost-effectiveness research institute, ISPOR met with its representative Alain Enthoven, Professor, Stanford University to discuss issues of common interest. National Association of State Insurance Commissioners (NAIC) - ISPOR commented on NAIC's Health Carrier Prescription Drug Benefit Management Model Act. ISPOR supported the use of sound scientific evidence in the development of drug formularies as a basis for decisions. However, ISPOR viewed Section 3. V(2) of the Model Act [i.e. "Medical and scientific evidence" shall not include published peer-reviewed literature sponsored by the industry] as inappropriate and unnecessary and successfully influenced the deletion of this Section from the Model Act.

Health Insurance Association of America (HIAA) - ISPOR met with HIAA staff to discuss initiatives of common interest. Academy of Managed Care Pharmacy (AMCP) - ISPOR issued a letter of support to AMCP for the development of explicit guidelines for decision-making based on evidence of health outcomes with regard to the "AMCP Format for Formulary Submissions" document. ISPOR submitted to AMCP a Pre-Meeting Symposium prior to the AMCP Fall 2001 Meeting, titled "Bridging the Gap: Utilizing Health Economics, Outcomes Research - Partnerships to Enhance Formulary Decision-making" as a forum to discuss issues relevant to the AMCP formulary development document.

World Health Organization (WHO) - ISPOR participated in a meeting of 41 'experts' from around the world representing the OECD, World Bank, WHO and the United Nations to consider the issue of a common framework for the measurement of population health.

National Institute for Clinical Excellence (NICE) - ISPOR, with the PhRMA Health Outcomes Committee sponsored a symposium with key speakers, Carole Longson PhD, NICE Appraisals Program Director, and Rod Taylor BSc(Hons), MSc, PhD, former Director, to discuss the NICE Guidelines prior to the ISPOR Annual Meeting.

Food and Drug Administration (FDA) - ISPOR, with the PhRMA HOC, ISoQoL and ERIQA, are working with the FDA in the development of consensus on patient-reported outcomes (PRO) assessment such as health-related quality-of-life measures.

I believe ISPOR has learned thus far that the agendas and responsibilities of individuals in these other organizations often cause them to view health care and its provisions differently from what we might consider to be an ISPOR point-of-view. Such differences create the potential for misunderstandings, miscommunications, and frustration. However, they also create opportunities for understanding other perspectives and priorities, by which ISPOR may then influence as well as be influenced.

As ISPOR members, when we engage in Bridging the Gap" communications, we must remember to always act in the best interest of the public health and individual patients. While gaining new flexibility in the application of our research, we must continue to develop and apply the best research methods and follow scientifically sound principles. We should also encourage those we contact to make decisions on the basis of the best scientifically generated evidence and in the best interest of the public health and individual patients.

If we in ISPOR promote this perspective as we reach out to other organizations when "Bridging the Gap," we will steadily move those whom we contact as well as ourselves toward fulfilling ISPOR's mission "to translate pharmacoeconomics and outcomes research into practice to ensure that society allocates scarce health care resources wisely, fairly and efficiently."

It has been a good year for ISPOR. I look forward to continuing to serve ISPOR as Past-President when Eva Lydick assumes responsibility as 2001-02 ISPOR President in July.

I want to thank Marilyn Dix Smith and her staff for their excellent work over the past year. I also want to personally thank Dr. Smith for her help and guidance to me as ISPOR President. She functions as much more than an Executive Director for the organization. She and her staff are an integral part of the heart of ISPOR.

Finally, I want to thank the membership for their support of ISPOR and particularly the ISPOR "Bridging the Gap" initiatives, which in my opinion, have only just begun.

Thank you. Jon Montague-Clouse


Messages from the ISPOR Presidents