OBJECTIVES: To assess the extent to which novel value factors are incorporated in ICER assessments and influence appraisal committee (AC) long-term value for money (LTVM) votes.

METHODS: We identified reports assessing pharmaceutical interventions published between 10/2017 and 10/2022, excluding those without an appraisal committee meeting (N=40). We extracted data on interventions, comparators, cost/QALY estimates, AC voting questions, and votes. We identified novel value factors in the questions and calculated inclusion frequency and average voting score for each factor across all reports. For each intervention/comparator, we categorized ICER’s cost-effectiveness value for money (CEVM) estimate as high-value ($0 - $50,000 cost/QALY), intermediate-value ($51,000 - $175,000 cost/QALY), or low-value (> $175,00 cost/QALY) and compared it to the distribution of AC LTVM votes.

RESULTS: 22 novel factors were identified in AC votes. Factors most frequently included were caregiver impact (n=38 reports), disease severity (n=37), lifetime burden of illness (n=36), and health equity (n=29). Novel factor inclusion was inconsistent, partly due to the impact of ICER’s evolving assessment framework on AC voting questions and response scales. Across all reports, high average AC voting scores indicated lifetime burden of illness, novel mechanism of action, and regimen complexity were often identified as impactful when evaluating LTVM. Conversely, treatment ability to reduce health inequities received neutral scores. LTVM votes often differed from CEVM categorizations, suggesting novel factors have some impact: high-value CEVM treatments received 23% high, 55% intermediate, 12% low LTVM votes; intermediate-value CEVM received 17% high, 58% intermediate, 24% low LTVM votes; low-value CEVM received 2% high, 22% intermediate, 76% low LTVM votes.

CONCLUSIONS: Novel factor inclusion is inconsistent across ICER reports. Lifetime burden of illness was often included and earned a high average AC voting score, while health equity considerations earned a low score. Differences in CEVM and LTVM categorizations indicate that novel factors likely have some impact on AC votes.