OBJECTIVES: The Institute for Clinical and Economic Review (ICER) is an independent organization that reviews selected drugs and devices with a focus on emerging agents. As part of their evaluation, ICER estimates value-based prices (VBP) at $50,000 to $150,000 per quality-adjusted year (QALY) gained. We compared actual list prices to estimated VBP across ICER evaluations.

METHODS: We reviewed ICER final evidence reports from November 2007 to January 2020 and created a database comprised of characteristics such as year of final report publication, therapeutic area, intervention, expected number of patients treated each year, VBP, list price and net price in the ICER report, and current wholesale acquisition cost. ICER-estimated VBPs were compared to list prices in the ICER report, or where unavailable, current wholesale acquisition cost.

RESULTS: A total of 34 of 63 ICER reports provided VBPs for 100 interventions which could be paired with ICER list prices (n=95) or current list prices (n=5). The list price of 95% of interventions exceeded the $100,000/QALY VBP and 86% exceeded the $150,000/QALY VBP. The median discount needed to reach $150,000/QALY was 46% (IQR 24%, 63%) overall, and was highest for respiratory disorders (65%), inherited disorders (59%) and multiple sclerosis (54%). The median discount needed to reach $150,000/QALY was 57% for interventions targeting small patient populations. Of 10 interventions evaluated under the ICER ultra-rare framework, the list price for 6 fell under the $500,000/QALY VBP.

CONCLUSIONS: List prices are consistently above VBPs estimated by ICER, with approximately 75% of interventions needing a ≥25% discount to be considered cost effective at a willingness to pay threshold of $150,000/QALY under the ICER framework. Although gaining awareness among decision-makers, the long-term impact of ICER evaluations on pricing and access to new interventions is unknown and further obscured by confidential discount and rebate agreements between payers and manufacturers.