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LETTERS

Letter to the Editor: Covid-19 cost-effectiveness research deepens racial disparities

Kevin Kimble

A newly released study by the Institute for Clinical and Economic Review (ICER), a Boston-based nonprofit, attempts to answer a weighty question: How much should it cost to treat the coronavirus?

The study evaluated remdesivir, one of the most promising treatments for COVID-19 yet discovered. Its authors determined that the drug warrants a price between $4,580 and $5,080 per treatment course.

This analysis is purportedly based on objective science and cold hard statistics. But a closer look at ICER’s methods reveals a bias against disadvantaged populations, particularly minorities.

This isn’t surprising. For years, ICER has reduced human life to dollars and cents and has done so in ways that systematically undervalue the well-being of those who are sick and disabled. That its latest analysis demonstrates prejudice is expected.

Central to ICER’s cost effectiveness model is a controversial unit of measurement known as a quality-adjusted life year, or QALY.

According to this approach, a drug that adds a year of perfect health to a patient’s life provides one QALY. If it adds a year of less-than-perfect health, it might provide 0.8 QALY. Using this metric, governments and insurers may determine a given drug isn’t worth paying for based on the long term health benefits of the patient.

In ICER’s analysis of remdesivir, researchers used QALYs to determine how much the drug should cost in the first place.

Attempting to place a dollar value on human life is never a defensible calculation. But there’s an even more onerous implication behind QALY analyses: they systematically undervalues certain populations.

Consider that many patients -- particularly with debilitating chronic conditions and disabilities -- will never be in “perfect” health. QALY analyses may determine that extending the life of patients with blindness, heart disease, kidney disease, cancer, diabetes, or paralysis isn’t as worthwhile as extending the life of those who are healthier.

As a result, these analyses undervalue future COVID-19 medications -- like remdesivir -- considering many COVID-19 patients battle underlying health conditions and might never achieve perfect health.

The innate bias of these QALY calculations disproportionately affects minority Americans. These Americans are more likely than white Americans to suffer from underlying chronic diseases.

For instance, African Americans are 8.4 times more likely to be diagnosed with HIV, and 50 percent more likely to have high blood pressure. Meanwhile, Hispanic Americans have more than a 50 percent chance of developing type 2 diabetes, compared to 40 percent for the population as a whole.

COVID-19 has ravaged minority communities in the United States. According to the Centers for Disease Control, African Americans account for more than 26 percent of COVID-19 cases, despite making up 13 percent of the overall population. Hispanics are overrepresented among COVID-19 patients. This population comprises nearly 29 percent of cases, while constituting 18 percent of nation’s population.

Yet ICER’s calculations devalue the medicines that would deliver outsized benefit to our communities. And although the group is an independent entity, it has sway with federal and state policymakers. If government officials ever heed ICER’s advice, the long-term implications would prove devastating.

Placing a dollar figure on human life is unconscionable. But ICER takes it further by putting a lower dollar figure on the health of minorities, chronic disease patients, and those with disabilities. Shame on them. If it were up to groups like ICER, our nation’s healthcare inequities will continue after the coronavirus crisis is over.

Kevin Kimble is a member of the Health Equity Collaborative, a community-based resource center designed to inform, educate, and elevate the voices of America’s most vulnerable and underserved communities.