OBJECTIVES : The Institute for Clinical and Economic Review (ICER), is an independent research organization in the US, that performs cost-effectiveness and budget impact analyses for pharmaceuticals. Unlike some health technology assessment (HTA) bodies, ICER lacks the formal authority to make reimbursement and pricing decisions. Instead, ICER publishes non-binding recommendations and, within the final assessment reports, estimates discounts required for pharmaceuticals to achieve pre-specified cost-effectiveness thresholds. We compare ICER’s threshold prices and current prices in the US, UK and Canada for pharmaceuticals assessed by ICER from 2016 to 2018.

METHODS : We obtained US drug prices using US Wholesale Acquisition Cost (WAC) and Average Sales Price (ASP) data from commercial and government payers, respectively; UK list prices via the Monthly Index of Medical Specialties (MIMS), and Canadian prices via available sources such as the Association Québécoise des Pharmaciens Propriétaires (AQPP) and the Ontario Drug Benefit (ODB) formulary. We compared these costs to the ICER-reported prices based on $100,000 and $150,000 cost per quality-adjusted life-year (QALY) thresholds. The exchange rates were based on average purchase power parity between 2016 and 2019. The differences were aggregated by the therapeutic area and drug class.

RESULTS : Preliminary results highlighted that both US WAC and ASP prices substantially exceed threshold prices for the majority of drugs using either the $100,000 or $150,000 thresholds. The UK and Canada drug prices are much closer to, or under, the threshold prices estimated by ICER using the $100,000 threshold.

CONCLUSIONS : US drug prices paid by commercial and government payers are generally higher than the cost-effectiveness price estimated by ICER with a $100,000 cost per QALY threshold; the drug prices in the UK and Canada closer to, or below, this threshold price. A key limitation is estimating any discount based on US WAC or ASP price in practice given the non-transparent nature of US pharmaceutical pricing.