Influencers on Icer and the Evolving IMPACT of Icer on US Formulary Decision Bodies
Author(s)
Lodowski N1, Sander Kirschenbaum J2, White N2, Huang Y3
1PRMA Consulting, Jersey City, NJ, USA, 2PRMA Consulting, Philadelphia, PA, USA, 3PRMA Consulting, Fleet, UK
OBJECTIVES This research aimed to analyze ICER assessments in the US to determine the quantity of pharmaceutical therapies assessed at the various QALY thresholds, as well as suggested discounting to reach QALY thresholds. METHODS Publicly available ICER final evidence reports were used to analyze determination of cost-effectiveness at QALY thresholds at $100,000 and $150,000. Thresholds were analyzed across 111 treatments from 27 ICER assessments conducted between 2015 and 2020. Reports were also reviewed to analyze ICER determined price discounts required from the US list price to achieve the cost per QALY threshold price at $100,000 and $150,000. RESULTS Most of the drugs ICER assessed exceeded the commonly accepted $100K-$150K per QALY gained threshold. Three-quarters did not demonstrate cost-effectiveness at a $100K and/or $150K QALY threshold (76.6% (n=85) and 73.0% (n=81), respectively). Conversely, around a quarter of pharmaceuticals assessed were found to be cost-effective at a $100K and/or $150K QALY threshold (23.4% (n=26) and 27.0% (n=30), respectively). Of those cost-effective therapies, a very small percentage would remain cost-effective even with a price increase (3 at $100K and 8 at $150K QALY threshold). The analysis also found that most of the drugs reviewed would need to be discounted to meet the commonly accepted thresholds for cost-effectiveness. To meet the $100K threshold, drugs would need to be discounted anywhere from 4% to 94%, drug dependent, with an average discount of 48%, while achieving the $150K threshold would require a discount anywhere from 10% to 98%, with an average discount of 65%. CONCLUSIONS As predicted, ICER determined that most therapies assessed were not cost-effective at their US list price and would need substantial discounting to achieve cost-effectiveness at thresholds of $100K-$150K. While most US payers have not historically assessed products based on cost-effectiveness thresholds, ICER and cost-effectiveness is becoming increasingly important in the US.
Conference/Value in Health Info
2020-11, ISPOR Europe 2020, Milan, Italy
Value in Health, Volume 23, Issue S2 (December 2020)
Code
PNS129
Topic
Health Policy & Regulatory, Health Technology Assessment
Topic Subcategory
Decision & Deliberative Processes, Reimbursement & Access Policy, Systems & Structure, Value Frameworks & Dossier Format
Disease
Multiple Diseases