The Institute for Clinical and Economic Review (ICER), of Boston, said it released an updated draft evidence report assessing the comparative clinical effectiveness and value of treatments for rheumatoid arthritis. Following an earlier version of the report in September, ICER's internal reviewers identified the need to reevaluate some of the assumptions and calculations in the report to better align its economic modeling with how patients transition between those therapies in the real world. In the updated model, patients that fail first-line treatment now transition to a market basket of targeted immune modulators, instead of palliative care. Also, because clinical differentiation between those therapies is uncertain over time, their cost-effectiveness will be analyzed in the first year of use, instead of over a patient's lifetime. With that new update, the public comment period on the draft report has been extended until Nov. 8. Based on stakeholder feedback, ICER said it may revise key assumptions and findings for its evidence report, which will be published on Nov. 26. The report will be subject to deliberation during a public meeting of the California Technology Assessment Forum, one of ICER's three independent evidence appraisal committees, on Dec. 9.