Presentation (CTI)

OBJECTIVES: Multi-indication therapies are typically reimbursed at a single uniform price despite differing cost-effectiveness across indications, creating a price-value mismatch. We developed an optimisation framework to quantify the population-health and access losses of uniform pricing relative to indication-based pricing (IBP), and to derive value-aligned indication-specific prices.
METHODS: For a therapy with K indications - each characterised by incremental QALYs, comparator costs, eligible population and willingness-to-pay (WTP) threshold - we formulated a constrained optimisation maximising net health benefit subject to a fixed payer budget and indication-level WTP ceilings, under two regimes: (i) a single uniform price and (ii) indication-specific prices. We applied it to an illustrative interleukin-inhibitor across four immune-mediated indications using published efficacy and cost inputs, with probabilistic and one-way sensitivity analyses on thresholds, populations and budget.
RESULTS: Uniform pricing forwent 18% of attainable net health benefit relative to indication-based pricing. Value-aligned annual prices ranged from $33,000 to $69,000 across indications versus a uniform $51,000; under a fixed budget, IBP treated 2,300 additional patients. The distortion was driven chiefly by the lowest-incremental-benefit indication, where the uniform price exceeded the value-based price by 38%. The IBP advantage was greatest at lower WTP thresholds and larger low-value populations.
CONCLUSIONS: Uniform pricing can forgo a substantial share of attainable population health and restrict access relative to value-aligned indication-based pricing. The framework gives payers and manufacturers a transparent, reproducible basis for negotiating differential pricing and managed-entry agreements, while surfacing the data-infrastructure and operational mechanisms IBP requires.