Presentation (CTI)

OBJECTIVES: Estimates of relative value from cost-effectiveness analysis (CEA) can be informative, but only if the model and underlying assumptions sufficiently reflect key aspects of the healthcare setting of the decision problem. In the decentralized U.S. setting, different payers face different prices, and frequent price changes elevate the importance of assumptions about their evolution. In addition, rebating and other discounts can be substantial, so a key analytical choice is what price metric to use. The Second Panel states that prices should “reflect the transaction prices from the perspective of the analysis”. List price which excludes rebates, or net price which excludes other discounts retained by intermediaries like pharmacy benefit managers, for example, would not be appropriate metrics if the perspective was societal. The Generalized CEA (GCEA) framework, which integrates some important analytical advances in the field, highlights the importance of generic and biosimilar entry for comparative value estimates via price changes. Our objective was to assess the adequacy of GCEA guidance on parameterizing prices for informing U.S. applications.
METHODS: We reviewed GCEA literature for recommendations for parameterizing intervention prices, assessed their consistency with best practices, and analyzed potential implications for healthcare decision-making.
RESULTS: The GCEA framework recommends incorporating both pre- and post-genericization price changes, but case studies have focused on parameterizing generic entry. Challenges associated with predicting future prices have been outlined and noted as a limitation. To date, GCEA publications have not offered discussion on the choice of price metrics.
CONCLUSIONS: A key feature of the U.S. setting is underscored in the GCEA framework, namely the dynamic nature of pricing. However, future work on predicting prices over the life cycle and guidance on which price metrics reflect true economic costs from different perspectives is needed.