| Summary: | It has been demonstrated conclusively that value and utility preference scores have only ordinal properties. This means, as has been pointed out on numerous occasions that the quality adjusted life year (QALY) is a mathematically impossible construct. The implications are profound: some 30 years of health technology assessment is rendered worthless due to a failure to recognize the well documented limitations imposed by the axioms of fundamental measure. Yet these are ignored in favor of persevering with the QALY as though it has mystical measurement properties, a ratio scale in disguise that allows QALYs to be imagined. This denial of the relevance of these axioms by the Institute for Clinical and Economic Review (ICER) has been the long-standing position and in the case of the just published ICER final evidence report on JAK Inhibitors and monoclonal antibodies (released on 17 August, 2021), shared by its contracted model builders at the College of Pharmacy, CHOICE Institute at the University of Washington, Seattle. The fact that an academic center should support ICER’s denial of fundamental measurement and the construction of evidence should come as no surprise as professional groups such as the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) are equally complicit in this denial. Interestingly, this denial appears to extend to ignoring peer reviewed studies that have considered alternative frameworks for evaluating quality of life in atopic dermatitis. This applies to the Quality of Life Index of Atopic Dermatitis (QoLIAD) and the Parents’ Index of Quality of Life in Atopic Dermatitis (PIQoL-AD) instrument. These are the only two quality of life instrument in atopic dermatitis that meet the required axioms of fundamental measurement. . The purpose of this commentary is to address once again ICER’s (and the CHOICE Institute’s) failure to understand the difference between science and pseudoscience, irrespective of numerous critiques of the denial and misuse of preference scales. The creation of mathematically impossible simulations continues; driven by assumption without credible and evaluable claims for therapy response. ICER is operating in an analytical dead end; a basis for creating pricing and access recommendations that should be rejected out of hand. Yet, ICER perseveres. Truly, ignorance is bliss.
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