OBJECTIVES The Institute for Clinical and Economic Review (ICER) is a self-described “independent watchdog on drug pricing” in a country (US) that legally prohibits many federal agencies’ use of cost-effectiveness analysis. The impact of their reports on drug prices and coverage remains unclear, however, as stakeholders seek to influence public discourse regarding the organization. We performed a systematic review and a content analysis (a method used to highlight trends for qualitative analysis) of peer-reviewed and non-peer-reviewed media from 2015-2017 to better understand which stakeholders expressed opinions about ICER and categorize their comments.

METHODS We searched four databases (PubMed, Google Scholar, Nexis Uni, and ProQuest) for peer-reviewed journal articles and other written news media published between 01/01/2015 – 12/31/2017 containing the phrase “institute for clinical and economic review.” Articles were included for analysis if they discussed one or more aspects of the ICER organization beyond technical results. Discussion statements were extracted, coded, and categorized by stakeholder and general subject.

RESULTS We identified 29 peer-reviewed articles and 118 non-peer-reviewed articles that met our inclusion criteria. All peer-reviewed article discussions were normative, 31% were published in “Value in Health,” and the most commonly discussed subject was the overarching definition of value. Of non-peer-reviewed articles, 30 reported only positive statements on ICER, 61 reported only negative statements, and 27 reported both positive and negative statements. Positive comments were most often related to ICER’s impact on payers (67%) and the overall health system (46%), while negative comments centered around patient drug access (61%), modeling assumptions (52%), and payer influence (51%).

CONCLUSIONS Opinions about ICER’s utility in the American drug market remain mixed, particularly concerning the definition of value and impact on patient access. ICER’s success in influencing the American drug market will ultimately depend how it is perceived and subsequent uptake of its reports.