Presentation (CTI)

OBJECTIVES: Dynamic pricing refers to the adjustment of drug prices over time in response to market, clinical, and policy signals such as reimbursement renewals, competition, wholesale price cuts, and patent expiry. Health technology assessment (HTA) typically relies on cost-effectiveness analysis (CEA) based on a static price rather than accounting for real-world pricing dynamics. This study explores how dynamic pricing affects the lifetime incremental cost-effectiveness ratio (ICER) and the maximum ICER at launch.
METHODS: A modeling study was conducted using information about supply-side and demand-side willingness-to-pay thresholds, price adjustments related to regulation, and the share of quality-adjusted-life-years (QALYs) accrued during the patent and post-patent phases as a proxy for demand.
RESULTS: The launch ICER may be 1.2 to 2 times higher than the threshold value when accounting for variability in the parameters used in the calculation of dynamic pricing. With a threshold value of €35,000 / QALY, the cumulative lifetime ICER equals the threshold with the maximum ICER at launch of appr. €58,000 under the most plausible parameter values. The most sensitive parameters are QALY accumulation during the pre- and post-patent periods (base-case 50-50%), and the launch ICER relative to the threshold. Discounting, the number of price renewals, price increase according to inflation, length of patent and post patent periods in years and the generic price level had a lower impact.
CONCLUSIONS: Typically, cost-effectiveness models and HTA guidelines do not account for or permit dynamic pricing. As a result, lifetime cost-effectiveness may be underestimated, potentially leading to negative reimbursement decisions. While incorporating dynamic pricing may introduce additional uncertainty, it may yield more realistic estimates of cost-effectiveness.