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Meeting round-up: ISPOR Annual 2023

Meeting round-up: ISPOR Annual 2023

Author: Chris Sampson

How late is too late for a meeting round-up? A whole month has passed since the latest US ISPOR conference in Boston, but it seems like I’ve only just conquered my inbox since returning. Well, I’m here to tell you all about ISPOR anyway. And, hey, the conference is still going because you can access most of the sessions online. Timely content!

This was my second IRL US ISPOR meeting. The venue was not quite as mind-boggling as the last one, but I believe it was still a record-breaking meeting in terms of attendees.

I only had one real responsibility at the conference, which was an issue panel on digital therapeutics. Consistent with previous meetings, digital health was a strong theme, to the extent that there was another issue panel with an almost identical scope to ours. Both sessions were well attended, so there is still a lot of curiosity about this stuff.

Discussion of digital health technologies in the HEOR community is shifting from questions about evidence to questions about reimbursement. As I see it, there are two significant facilitators for the reimbursement of digital therapeutics and other digital health technologies: centralisation and flexibility. Centralisation of responsibility for reimbursement is important because of the size of the challenge; commentators routinely cite the availability of several hundred thousand health-related apps. In this environment, there is little hope for individual actors to make evidence-based decisions about reimbursement. Flexibility is crucial because of the wide variety of technologies available. Heterogeneous technologies require different evidence and, probably, different pricing models. The US seems to be failing on both counts, with FDA hegemony and a dispersion of payers and providers. Unless we see change, Pear Therapeutics may prove to be the canary in the mine. Here in the UK, we're not doing any better, but there are rumblings of promise.

The Evidence Base kindly spoke to me and my fellow panellists about our session, so you can read more about our thoughts on this topic.

But digital health was not the stand-out topic at this meeting. That trophy goes to the IRA (cue cognitive flinches for British readers). My OHE colleagues were engaged in this discussion, and my colleague Amanda has done a much better job of summarising the content than I could, so I really recommend you go and read that, especially if you don’t know what this IRA is.

As is typical, I found the plenary sessions mostly disappointing. I'm not sure who is demanding such heavily scripted and intentionally uncontroversial performances. Loosen the reins, ISPOR! Mix it up! Invite some people who will let their opinions rip! The exception was the plenary chaired by Sam Roberts, who is a brilliant moderator. Sam whipped up some engaging back-and-forth between Mike Drummond and John O'Brien on the topic of affordability. This was loosely inspired by the IRA but more generally discussing mechanisms such as industry rebates used to control medicines spend around the world.

Beyond the plenaries, there were plenty of enjoyable sessions. A highlight for me was Dan Ollendorf's issue panel, which presented real disagreement and tension (and ankle-flashing, as you might've seen on Twitter). The topic was transparency in HTA, a genuinely tricky problem with no obvious point of equilibrium. The stand-out speaker was Sneha Dave, the impressive young founder of Generation Patient, whose clarity of vision and purpose made fuller transparency the winning argument on the day.

As of this month, my 3-year stint as (past-)Chair(-elect) of the Open Source Models SIG comes to an end, and my last act was to help (albeit minimally) in the organisation of a forum session on 'definition'. The idea - arising from past discussions at ISPOR meetings - was that we need to figure out what 'open source model' actually means. In a time-honoured academic fashion, the forum session tentatively concluded that 'it depends', but that guidance and standards around open-source practices in HEOR (and the use of particular labels) are needed. There's plenty more work for the SIG to be doing on this. Join the SIG!

A curious move by ISPOR for this meeting was to have 'digital attendance' priced entirely separately. Thus, I was recorded delivering my issue panel talk, but I'd need to pay for the privilege to see that recording; I'm not sure how much, but the standalone price is $650. Presumably, this has something to do with the provider charging ISPOR per user. It seems foolish to me and is certainly annoying for a presenter. The marginal cost (if not the price) of providing access to attendees must be close to zero. Another whinge from me on the feedback form was the poor show of vegan food offerings (same salad both days and on the second day they ran out).

All in all, this was an enjoyable and productive ISPOR meeting. People are out of their COVID cages and the event felt very sociable for me. I was lucky to meet up with some old friends and make some new ones*. For the first time in my experience of ISPOR meetings, people were actually making good use of the conference app, which made it a lot easier to track people down for conversations or follow up afterwards.

After the conference, I had a couple of extra days in Boston, playing solo tourist. Boston isn't the most iconic or exciting US city I've visited, but it's got plenty going for it. If you're interested in history, beer, or waterside running and cycling, (or team sports, I guess,) you should take the opportunity to visit.

*Jerry, if you're reading this, I'm sorry I never called.

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